Home » YouthWorks Youth and Elders Program Application Group Name* Date of visit:*Please enter the date your group will be participating with Bessie's Hope. If you do not know the exact date, please estimate (you can put the date that you will start your service project in Denver). MM slash DD slash YYYY Primary Phone Number for Group*In case your group gets lost or Bessie's Hope needs to contact the group for last minute changes, what is the best number for us to have? Group LeaderName First Last Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific Cell PhoneEmail* I Understand that each participating youth must have a waiver and release:*The waiver and release must be signed by a parent or other responsible party. These can be given to the Bessie's Hope representative on the day of the visit. I Agree Group DemographicsPlease estimate the demographics of your group. This information is important for some of the grants that help Bessie's Hope exist. Skip this if your group does not have youth involved.Number of Adult Volunteers 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.
