Young Adult Guiding Coalition (YAGC) Application
About You
Legal First Name
Legal Last Name
Preferred Name or Nickname
Preferred Pronouns
Please select...
She/Her/Hers
He/Him/His
They/Them/Theirs
Ze/Zir/Zirs
Ze/Hir/Hirs
Name Only
Any/All Pronouns
Prefer not to share
Email Address
Phone Number
Birthday
Are you of Hispanic or Latino origin?
Please select...
Yes, Cuban
Yes, Mexican, Mexican American/Chicano
Yes, Puerto Rican
Yes, other Hispanic or Latino
No
What race/ethnicity do you consider yourself? Select all that apply
American Indian or Alaska Native
Asian Indian
Cambodian
Chinese
Filipino
Japanese
Korean
Laotian
Thai
Vietnamese
Black or African American
African
Caribbean
Guamanian
Native Hawaiian
Samoan
European
Middle Eastern
North African
Other
Please describe "other"
Have you been involved with Eye to Eye before?
Please select...
No, I have never been part of Eye to Eye's programs
As a Mentor
As a Mentee
As a Chapter Leader
As an intern
As an LD Alliance club member
Application
Please submit your answers to the following questions in writing, or by uploading a video or audio clip
Video or audio can be uploaded here
How do you identify with the neurodiverse experience?
Why are you interested in becoming a member of the YAGC?
What skills and knowledge do you have that makes you uniquely qualified for this role?
Are you able to attend the OI this year (August 3rd - 7th)?
Yes
No
Maybe
Upload your
resume
outlining any current or previous jobs, leadership experience, education, and/or extra curricular activities
Contact Information