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

CityState / Province

Postal / Zip CodeCountry
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 NameLast Name
CHILD FULL NAME
1. Teen's Date of Birth*

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

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

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

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

MonthDayYear
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)*

YesNo, 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.
Should be Empty:

GROWING UP GROUNDED