Moderators for DALLAS Regional Deliberations Form

Thank you for your interest in serving as a moderator for NextGen Roundtable: New York City Youth Summit at Civic Hall on May 15, 2026! Please register by filling out your information below. Once you have registered, Close Up will be in touch with more information about training and the event itself.

Name(Required)

Address

School Name(Required)

School Email(Required)

Phone(Required)

Personal Email(Required)

Date of Birth(Required)

How did you find out about serving as a moderator for the NextGen Program?(Required)

Are you a Close Up Alum?(Required)

Yes - Student

Yes - Teacher

Yes - Former Staff

What is your major or field of interest?(Required)

Are you a member of any civic organizations?(Required)

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Moderators for Dallas Regional Deliberations Form