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?*

Yes

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

Enter International

Home Phone Number

Enter International

Address

We need your address for our records. Also, sometimes we need to mail you things for participating in MYVoice activities.

Current Location Type*

Current Location Street Address*

Bldg./Apt. #

Current Location City*

Current Location State*

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)

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

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

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

Pronouns Other (If other or multiple pronouns, please type in desired pronouns)**

Pronoun Notes

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?*

Yes

Adult First & Last Name**

Adult Contact Phone Number**

Enter International

Adult Email Address

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

Submit