MYVoice New Youth Form

Joining MYVoice activities for the first time? Please fill out this form with some basic info about yourself.

Name & Birthdate Are you a Minnesota young person between the ages of 12 and 22, who has been in foster care or adopted?* YesNo First Name* Last Name* Preferred Name Birthdate* Contact Information Please note that by giving us your email address, we will be adding you to our youth-specific email newsletter. We send out 1-2 emails per month. You can unsubscribe to this list at any time. For your phone number, we often text announcements about MYVoice activities. Please include your phone number if you're ok with us using it to text, call, or leave messages for you about MYVoice activities. Youth Email Cell Phone Number ()-ext Enter Int'l Number Home Phone Number ()-ext Enter Int'l Number Address We need your address for our records. Also, sometimes we need to mail you things for participating in MYVoice activities. Current Location Type* Adoptive Home Adoptive Relative's Home Biological Parent's Home Biological Relative's Home Concurrent Planning Detention or other Correctional Facility Extended Foster Care/IL Foster Home - Kin Foster Home - MITH Foster Home - Non Kin Group Home Homeless/Couch Hopping Hospital Living Independently Pre-Adopt Home Residential Treatment Respite Shelter   Current Location Street Address* Bldg./Apt. # Current Location City* Current Location State* AK - Alaska AL - Alabama AR - Arkansas AS - American Samoa AZ - Arizona CA - California CO - Colorado CT - Connecticut DC - District of Columbia DE - Delaware FL - Florida FM - Federated States of Micronesia GA - Georgia GU - Guam HI - Hawaii IA - Iowa ID - Idaho IL - Illinois IN - Indiana KS - Kansas KY - Kentucky LA - Louisiana MA - Massachusetts MD - Maryland ME - Maine MH - Marshall Islands MI - Michigan MN - Minnesota MO - Missouri MP - Northern Mariana Islands MS - Mississippi MT - Montana NC - North Carolina ND - North Dakota NE - Nebraska NH - New Hampshire NJ - New Jersey NM - New Mexico NV - Nevada NY - New York OH - Ohio OK - Oklahoma OR - Oregon PA - Pennsylvania PR - Puerto Rico PW - Palau RI - Rhode Island SC - South Carolina SD - South Dakota TN - Tennessee TX - Texas UT - Utah VA - Virginia VI - Virgin Islands VT - Vermont WA - Washington WI - Wisconsin WV - West Virginia WY - Wyoming Enter Region Current Location Zip Code* Date Youth Arrived at Current Location* Race/Ethnicity What race/ethnicity do you identify as? Check all that apply. If you race/ethnicity is not listed, please select other and type in your race/ethnicity in the "Race/Ethnicity Other" field. Race/Ethnicity (please select all that apply) African Continent - New American American Indian or Alaska Native Asian American Black or African American Hispanic or Latinx Native Hawaiian/Other Pacific Islander SE Asian-New American White/Caucasian Other   Race/Ethnicity Other (If other, please type in race/ethnicity)* * Race/Ethnicity Notes Sexual Orientation If you are willing to share it, what is your sexual orientation? Sexual Orientation Gay/Lesbian Straight/Heterosexual Bisexual/Pansexual Questioning Other   Sexual Orientation Other (If other, please type in other sexual orientation/s)* * Sexual Orientation Notes Gender Identity If you are willing to share it, what is your gender identity? Gender Female Male Non-binary/Genderfluid/Gender Queer Questioning Transgender/FtM/Assigned Female at Birth Transgender/MtF/Assigned Male at Birth Other Client doesn't know   Gender Other, (If other, please type in other gender/s)* * Gender Notes Pronouns Please select the pronouns you want us to us when referring to you. If you have questions about pronouns, you can copy and paste this link into a new webpage tab to learn more: https://bit.ly/3kc100X Pronouns Youth Uses He/Him She/Her They/Them Other or Multiple Pronouns   Pronouns Other (If other or multiple pronouns, please type in desired pronouns)* * Pronoun Notes How Did You Hear About MYVoice? How did you hear about MYVoice? Case Worker/Social Worker/County Worker Ampersand Families Adoptive/Pre-Adoptive Family Foster Family MYVoice Social Media Foster Advocates MNAdopt YMCA Connections to Independence (C2i) Other   (If Other, please type in name)* * Adult/Emergency Contact If you are under 18, we need an adult we can contact, if needed. Please provide contact info for an adult we can contact about you? Are You Under Age 18?* YesNo Adult First & Last Name* * Adult Contact Phone Number* ()-ext * Enter Int'l Number Adult Email Address Who is this person to you?* Foster Parent Adoptive/Pre-adoptive Parent County Worker/Social Worker Relative Group Home Staff Other   Other Relationship* * Anything Else You'd Like Us to Know Is there anything else you'd like us to know about you right now? Like special considerations or interests you have? We look forward to having *your voice* as a part of MYVoice! Extra Information

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