Youth and Elders Demographic Update

If you have questions about this please call 303-830-9035 or email kelly@bessieshope.org.

Group Name*
Address*
Primary Mailing Address for Group

Street Address City State ZIP Code
Primary Phone Number for Group*
Please have each volunteer complete this waiver and release.
Update Primary Group Leader
Name
First Last
Address*
Street Address Address Line 2 City State
Home Phone
Cell Phone
Email*
Update Second Group Leader
Name
First Last
Address*
Street Address Address Line 2 City State
Home Phone
Cell Phone
Email*
Update Third Group Leader
Name
First Last
Address*
Street Address Address Line 2 City State
Home Phone
Cell Phone
Email*
Group Demographics
Please estimate the demographics of your group. This information is important for some of the grants that help Bessie's Hope exist.
Number of Adult Volunteers
Information about Youth Volunteers
For what dates will these youth be participating with your group?
Start Date
For school group, what are the start and end dates of your semester. For residential treatment groups, what are your session dates. If your group goes year round put 1/1/xxxx-12/31/xxxx, etc.
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Number of Youth Volunteers
Age Range of Youth
Number of Male
Number of Female
Number of Low Income
Number of African American
Number of Asian
Number of Caucasian
Number of Hispanic
Number of Native American
Number of "Other"
Questions or Comments:
If you have any specific questions or comments please type them here.