2022 ARISE NY! Anti-Bullying Youth Summit

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

This form counts as your registration for the event. Please complete and submit your registration by Friday, July 22, 2022. Please note that the Summit is ONLY OPEN TO YOUTH AGES 13-20.

Every year, as part of our Youth Program, Turning Point for Women and Families' hosts a full day Summit addressing bullying, racism and discrimination, as well as avenues of empowerment for youth to address these issues. This year, our Summit will be held on Saturday, August 20, 2022 from 11am-2pm EST and will take place virtually on Zoom.

Individuals who participate in the full Summit will receive a Certificate of Completion. In previous years, schools have offered students community service hours for participating in this Summit.

If you have any questions, please email info@tpny.org or call/text 718-550-3586. We look forward to seeing you at the Summit!

Email *

Participant's Full Name (This is how your name will appear on your certificate) *

Participant's Date of Birth *

YYYY

Participant's Gender *

Cisgender woman

Cisgender man

Transwoman

Transman

Other:

Participant's Race/Ethnicity *

Black/African American

Hispanic/Latino/Latina/Latinx

Asian/Pacific Islander

Middle Eastern/North African

Native American/Indigenous

Bi-Racial/Multi-racial

Other:

Participant's Phone Number *

Where do you live? *

Manhattan

Queens

Brooklyn

Bronx

Staten Island

Other:

Participant's Address

Participant's School *

Please select which topics you are most interested in learning more about.

Choice 1

Choice 2

Choice 3

Choice 4

Addressing Xenophobia

Bias/Discrimination

Privilege & Intervention

Cyberbullying

Clear selection

What other bullying and/or discrimination topics would you be most interested in learning more about?

What do you hope to gain from this Summit? *

Do you need a letter for community service hours? *

Yes

Maybe

How did you hear about us? *

Would you be interested and willing to showcase your talent at this Summit? Each set will be about 2-3mins. (Organizers of the event will be in touch with you if you are). *

Yes

Maybe

What are your talents (drawing, spoken word, beatbox, dance, etc.)?

Emergency Contact Name and Relationship *

Emergency Contact's Phone Number *

Any additional information

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms