2022 GROWING UP GROUNDED INTEREST FORM

GROWING UP GROUNDED

COMING OF AGE IN AN ERA OF CLIMATE CATASTROPHE
I. CONTACT INFORMATION
Your Name *

First Last
PARENT FULL NAME
E-mail *
Phone Number *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
II. WHO ARE YOU INTERESTED IN APPLYING FOR?

Let us know who about each teen you'd like to participate.
1. Teen's Name *

First Name Last Name
CHILD FULL NAME
1. Teen's Date of Birth *

Month Day Year
AGE
1. What school is {1Teens} currently enrolled in? *
2. Teen's Name

First Name Last Name
CHILD FULL NAME
2. Teen's Date of Birth

Month Day Year
AGE
2. What school is {2Teens} currently enrolled in?
3. Teen's Name

First Name Last Name
CHILD FULL NAME
3. Teen's Date of Birth

Month Day Year
AGE
3. What school is {3Teens} currently enrolled in?
III. LOGISTICS
Are you able to pay the sliding scale amount for this program? (Between $2500 - $3000 per teen) *

Yes No, we would need financial assistance
Note: asking for Financial Assistance is not a deterrent to acceptance into the program. We do our absolute best to meet as many requests as we can!
What amount on the sliding are you able to pay? *
Between 2500 - 3000
How much would you be able to pay for this program? *
Between 0 - 2500
Thank you for taking the time to fill out this interest form! We will be in touch soon. In the meantime, please reach out to youthprograms@weavingearth.org if you have any questions.
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GROWING UP GROUNDED