OYC Regional Deliberation: Students

Please complete the form below to register and participate in A Day of Deliberative Dialogue. Through respectful dialogue, we aim to return the “civil” into public discourse. These events are part of Close Up Foundation’s NextGen Roundtable: America 250, a growing initiative to honor the Semiquincentennial of the United States through classroom resources, professional learning opportunities, and regional and national deliberations that connect our founding principles to the policy issues of today.

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)

Job Title(Required)

Teacher 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)

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino/a

Middle Eastern or North African

Native Hawaiian or Other Pacific Islander

White

Some Other Race

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)

OYC DELIBERATION: ENGAGING STUDENTS IN A DAY OF DELIBERATIVE DIALOGUE

Demographic Questions