I am a...

YOUTH (ages 13-24)

PARENT

STAFF

I am interested in...

Daily Text Messages only

Online Learning Resources only

BOTH Daily Text Messages and Online Learning Resources

HOW DID YOU HEAR ABOUT US? Arroyo High School Azusa Pacific University Azusa Youth and Family Center CCP- Community Collaboration Program Connections by Maryvale Da Vinci RISE High School DART Dream Resource Centers Duarte School District El Monte High School Elizabeth House Fernando Ledesma High School Foothill Unity Center Helpline Youth Counseling HYC/Long Beach Youth Advocates for Change Jovenes, Inc. LAUSD - Community Day School Maryvale Monrovia High School Mountain View High School Opportunities for Learning Public Charter School PEP- Prevention Education Program Rancho San Antonio Rosemead High School Santa Fe Middle School South El Monte High School Other - Please Specify

First Name

Last Name

Date of Birth (mm/dd/yyyy)

Age In Years

Address

 

City

State SELECT STATE Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip

  I do not currently have an address

Email

Mobile Phone

Social Media Handles (Optional)
Add as many handles as you want (Instagram, Twitter, TikTok, etc.) Include the network name and handle (i.e. Instagram-ProjectYouthWellness)