NextGen: Roundtable Deliberation in Fairfax Student Enrollment Form

NextGen Roundtable: Fairfax Youth Summit Student Enrollment

Please complete the form below to enroll and participate in the NextGen Roundtable: Fairfax Youth Summit with your school, taking place September 11, 2026, at George Mason University. Through respectful dialogue, we aim to return the “civil” to public discourse. If you are under 18 years of age, this form must be completed with a parent or legal guardian.

Student Name(Required)

Phone

Personal Student Email(Required)

Date of Birth

Parent/Guardian Name(Required)

Parent/Guardian Email(Required)

Parent/Guardian Cell Phone

School Name(Required)

Student School Email(Required)

Teacher's Name(Required)

Teacher's Email(Required)

Grade Level(Required)

Which, if any, of the following civics-related clubs or activities do you participate in?

What motivated you to participate in A Day of Deliberative Dialogue?

Promoted by a club/class

Requirement of a club/class

Interested in learning deliberative skills

Other

Demographic Questions

For educational and funding reporting purposes, Close Up requests that you provide the following demographic information. Such information will remain confidential and will not be used at any time for selection or placement criteria for the Close Up programs. Please complete all items below. Your cooperation is greatly appreciated.

Are you a member of a farm/migrant community?

Yes

Which best describes your school district?

Which best describes you? (please select one or more)

Is the participant 18 years of age or older at the time of signing this agreement?(Required)

Yes

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Adult Terms(Required)

I have read and agree to the Student Terms and Conditions.

Parent/Guardian Name(Required)

Parent/Guardian Initials(Required)

Opt-in
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Topic (CRM)

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