LGTBQ+ youth in grades 9th through 12th are welcome to apply to be a part of the first cohort of PYLA. PYLA aims to teach, inspire, and prepare LGBTQ+ youth with the skills to become agents of change within their own schools and communities.

If you are accepted to this program there is a $30 registration fee.  Scholarships for this fee are available if necessary.

 

Legal Name (required)

Preferred Name

Pronouns

Age (required)

Grade (required)

E-mail (required)

Phone# (required)

A liability release form will be sent to your parent or legal guardian.

Parent or legal guardian name (required)

Parent or legal guardian contact email (required)

Optional Information:

Gender

Sexuality

Race

Disability

Food Restrictions (if any)

Your mailing address:
Street 1:

Street2:

City:

State:

Zip:

Tell us about yourself and why you think this program would be beneficial to you.

Additional comments or questions: