Youth Digital Media Arts Application

This survey was created for Desert Soul Media, Inc., an educational non-profit. We will not sell or distribute your information to any third parties. This data is collected to better provide services to our target audience. You can find more information at www.desertsoulmedia.org.

Youth Participant Name

Youth Participant Email

Youth Participant Phone

If youth participant phone is a cell phone, do we have permission to send text messages to that phone number?

Yes No Not a Cell Phone Number

Parent, Guardian or Caregiver Name

Parent, Guardian or Caregiver Email

Parent, Guardian or Caregiver Phone

If parent, guardian or caregiver phone is a cell phone, do we have permission to send text messages to that phone number?

Yes No Not a Cell Phone Number

Which of the following interests you? (Mark all that apply)

What is your level of experience in Journalism? (please only respond if this is one of your areas of interest)

Expert (had training and can show evidence of my skill set) Experienced (Some training, I have a strong interest and desire a career in this area ) Novice (No training, I am interested and would like to learn more)

What is your level of experience in Community Activism? (please only respond if this is one of your areas of interest)

What is your level of experience in Health and Wellness? (please only respond if this is one of your areas of interest)

What is your level of experience in Engineering and Technology? (please only respond if this is one of your areas of interest)

What is your level of experience in Entrepreneurship? (please only respond if this is one of your areas of interest)

Explain your goals for learning journalism. What do you plan to do with the skills you will acquire in this program (150 word min)?