Youth Interest Survey

First Name *

Last Name *

Date of Birth *

What careers are you interested in? *

What is one goal you have set for the future? *

If you could learn something new, what would it be? *

Do you speak any languages other than English? *

YesNo

If yes, please list below

Check all of the words that best describe you. *

QuietTalkativeShyFriendlyFunSeriousAdventurousHelpfulMoodyHappySadActiveLonelyOutgoingPopularCautiousLoudHopefulOther

What's your favorite music group/artist? *

Who's your favorite famous person? *

What's your favorite food? *

What's your favorite movie? *

What's your favorite book or story? *

What's your favorite subject in school? *

What's your favorite video or computer game? *

Where's your favorite place to hang out? *

List two things you hate to do. *

List at least two things you feel like you do well.

What qualities do you value in an adult? *

Are there any other issues of importance that you would like to share with your mentor?

Why are you interested in participating with The Young Kings Movement program? *

What do you hope to get out of The Young Kings Movement program? *