KEYS Application
RequiredRequired Question(s)
2018 KEYS Alliance Leadership Program Application 
 
Required 1.
Student First Name:
 

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Required 2.
Student Last Name:
 

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Required 3.

Grade Level as of August 2017 

 

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4.
Date of Birth:
 

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5.
Gender:
Male
Female
Required 6.

Mailing Address: 

 

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7.
Mobile Phone Number: 
 

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8.
Can we send you text messages about upcoming KEYS meetings, activities, & events?
Yes
No
9.

Student Email:

 

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10.

Currently a Member of what clubs/organizations(examples- 4-H, Beta, FFA, etc)? 

 

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11.
Honors, Skills, or Special Recognition: 
 

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12.
Tell us anything else about yourself you think we should know?
 

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Required 13.
What are your opinions and beliefs about teen substance use (alcohol, drugs, etc.)?
 

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Required 14.
Do you work or are you a part of a youth team or group (ie, band, cheer team, football team)?
Yes
No
15.
If you answered yes to the above question, which days are your committed to work/practice each week? (please select all that apply) 
Monday
Tuesday
Wednesday
Thursday
Friday
Other  
  • Comment:

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Parent/Guardian Contact Information
 
Required 16.

Parent First Name: 

 

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Required 17.

Parent Last Name: 

 

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18.

Parent Email:

 

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Required 19.

Parent Mobile/Home Phone Number: 

 

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