Empower Youth Voices: Close Up & Malone Schools Interest Form - Close Up Foundation

Empower Youth Voices: Close Up & Malone Schools

Thank you for your interest in Close Up and the Malone Schools' Empower Youth Voices Programs for the 2021-2022 school year. These programs are open to students in 9th and 10th grade. Please complete the survey below to indicate which programs you would be interested in sending a student cohort to next school year.
Name*
First Last
School Name*
Position*
Address*
State
Email*
Phone*
How many students are you interested in sending to the Empowering Youth Voices: Deliberative Democracy program beginning on October 26th?*
How many students are you interested in sending to the Empowering Youth Voices: Deliberative Democracy program beginning on October 26th?
- One Cohort of 6 Students
- Other
Number of Students Interested
Do you know who the coordinator will be at the school?*
Do you know who the coordinator will be at the school?
- Yes
- No
- Maybe
Coordinator Name
Are you interested in joining an informational webinar in September?*
Are you interested in joining an informational webinar in September?
- Yes
- No
- Maybe
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Close Up Foundation
1330 Braddock Place, Suite 400
Alexandria, VA 22314

703-706-3300 or 800-CLOSE UP