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Youth Information Sheet

OYA (and its affiliated groups) is a group aimed at providing a safe space for LGBTQ+ youth and allies ages aged 13 through 23.

Youth must be between the ages of 13 and 23
Legal First Name
Legal Last Name
Youth's Preferred Pronouns
How do you identify? ex. Gay, Lesbian, Trans, etc.
Mental Health
On a scale of 1-5, with 1 being poor and 5 being great, how would you rate your overall mental health before joining our program?
Race
Select all that apply
Please keep an eye out for an email from us after submitting.
County
What county are you in or closest to?
Media Release
Media Release: From time to time, OYA may highlight attendees at social functions in efforts to promote OYA activities and achievements. Please tell us if it is ok for OYA to photograph or record you for use in electronic, digital, and printed media.
Final Confirmation
By checking this box, I agree that I am 13 or older and acknowledge that OYA may reach out via phone or email. OYA is funded in part by Orange County and may share basic information gathered on this form with Orange County for grant purposes.

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