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Certified ScrumMaster (CSM)

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KAI Partners, Inc.

1512 Eureka Rd. #215 Roseville, CA 95661
1-916-465-8065
info@kaipartners.com

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YOUNG ADULT APPLICATION FOR MEMBERSHIP (AGES 18 - 25)

* Initial selection deadline closed 11/17/2023. Application will remain open for quarterly review to ensure full membership body and waitlist.

IF SELECTED, I AGREE TO THE ELIGIBILITY AND COMMITMENT REQUIREMENTS LISTED ABOVE. *

Yes, I agree.

No, I do not agree.

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Legal Name *

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DEMOGRAPHIC INFORMATION

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How did you hear about the Youth Co-Lab? *

Lived Experiences - Select all that may apply. *

I have spoken with a professional about my mental or emotional health (like a therapist, counselor, peer worker, advocate, or behavior specialist).

I have received help or support with my use of alcohol and/or other drugs.

I have been in juvenile hall or a youth detention facility.

I have lived with a foster family, in a group home, or been cared for by a relative or family friend (also known as kinship care).

I identify as a person with a disability (could be physical, behavioral, developmental, or sensory).

Not Applicable (please describe your experience in the box below)

Please describe your personal experience related to mental, emotional, and behavioral health if the options above are not relevant to you:

If you are human, leave this field blank.

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YOUTH APPLICATION FOR MEMBERSHIP (AGES 14 – 17)

* Initial deadline closed 11/17/2023. Application will remain open for quarterly review to ensure full membership body and waitlist.

IF SELECTED, I AGREE TO THE ELIGIBILITY AND COMMITMENT REQUIREMENTS LISTED ABOVE. *

Yes, I agree.

No, I do not agree.

PERSONAL INFORMATION

Legal Name *

Legal Name

First

Last

Chosen or Preferred Name (if applicable)

Pronouns

She/Her

She/Ella

He/Him

He/Ello

They/Them

She/They

He/They

Ze/Zir

Self-IdentifySelf-Identify

Birth Date *

Email *

Home Number

Mobile Number *

Address *

Address

City

State/Province

Zip/Postal

DEMOGRAPHIC INFORMATION

Gender Identity *

Male

Female

Trans Male

Trans Female

Non-Binary

Two-Spirit

Gender Fluid

Gender Non-Conforming

Questioning/Unsure

Decline to Answer

None of these options fit? Tell us more.

Sexual Orientation *

Straight

Gay

Lesbian

Bisexual

Pansexual

Fluid

Queer

Questioning/Unsure

Decline to Answer

Racial Identity *

African American or Black

Asian or Pacific Islander

Latino/a

Native American or Indigenous

White/Caucasian

Multi-Racial (Identify with 2 or more): please specify in the box below

Unknown

Decline to Answer

None of these options fit? Tell us more.

How did you hear about the Youth Co-Lab? *

Lived Experiences - Select all that may apply. *

I have spoken with a professional about my mental or emotional health (like a therapist, counselor, peer worker, advocate, or behavior specialist).

I have received help or support with my use of alcohol and/or other drugs.

I have been in juvenile hall or a youth detention facility.

I have lived with a foster family, in a group home, or been cared for by a relative or family friend (also known as kinship care).

I identify as a person with a disability (could be physical, behavioral, developmental, or sensory).

Not applicable (please describe your experience in the box below)

Please describe your personal experience related to mental, emotional, and behavioral health if the options above are not relevant to you:

If you are human, leave this field blank.

Start Over