Cultural Wellness & Connection Fridays – RSVP
A safe space for youth, families, and community to grow, connect, and access support.
BASIC INFO
First Name
*
Last Name
*
Email
*
Phone
*
PARTICIPANT TYPE
Which best describes you?
*
Select
LOCATION
Zip Code
*
QUICK INTEREST
What are you most interested in? (Select up to 2)
*
Mentorship
Leadership
Technology / AI
Entrepreneurship
Creative arts
Just attending
WELLNESS (SUPPORT PATHWAY)
Would you like support in any of the following areas? (Select all that apply)
Managing stress
Personal growth
Guidance / mentorship
Someone to talk to
Not at this time
How do you identify?(Select all that apply)
African / African American / Black
Hispanic / Latino
White / Caucasian
Asian / Pacific Islander
Middle Eastern / North African
Native American / Indigenous
Prefer not to say
What is your gender?
Male
Female
Prefer not to say
CONSENT
Can we follow up with you about programs and opportunities?
*
Yes
No
Do you agree we may connect you with partner support if needed?
*
Yes
No
Media Consent (Photos/Videos)
*
Yes
No
ATTENDANCE
Will you be attending the next Cultural Wellness & Connection Friday session?
*
Yes
Maybe
Will you be attending alone or with guests?
*
Alone
With Guests
Guest Information (Names & Emails)
Submit
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