2019 Middle School Take Action Workshop Survey

July 22nd–26th, Monday–Friday, 10:00 AM–3:00 PM

For Middle School Students (entering 7-8th grade). Space is limited.

You have the power to make a difference.

This week-long workshop provides students with an opportunity to learn about local and global issues as well as participate in teambuilding activities to develop leadership skills. In addition, this year the workshop will have a special focus on Amplifier's We the Future Campaign.

"The We the Future campaign showcases ten young leaders representing ten diverse movements, each already building us a better world. They are drafting and passing legislation. They are working on climate justice, criminal justice reform, voting rights, immigration rights, disability justice, gun reform, queer rights, and literacy. Their work is nonpartisan, and it carries the energy of countless communities from every background." - Amplifier

To learn more about their campaign click here.

The program will include field trips, teambuilding activities, discussions with local social justice leaders, and more fun activities. Workshops are co-facilitated in collaboration with Gates Foundation Discovery Center's Youth Ambassadors and Storytellers for Change.

- Applications are due on Friday, April 30th or until space permits.

- Space is limited for all workshops.
- There is no cost to attend.
- All workshops will be held at the Bill & Melinda Gates Foundation Discovery Center.

- There are two off-site visits. Site visits will be within walking distance of the Foundation or we'll take public transportation.

Application Review Process:
We employ a holistic approach to reviewing applications. We value all applicants with extensive leadership experience as well as applicants who may just be starting to explore community involvement. The strongest applications articulate why this workshop will help you to make a difference in your community and in addressing the local and global issues you care about.

Questions: Contact Deborah Sepulveda, deborah.sepulveda@gatesfoundation.org

Location: The workshop will be held at the Bill & Melinda Gates Foundation Discovery Center 440 5th Ave North, Seattle, WA 98109

Data Privacy Statement:

Any data you provide on this application will be only be reviewed by Foundation Staff and workshop facilitators. We will keep your information confidential and we will not share any of your information with third parties.

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* 1. First Name

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* 2. Last Name

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* 3. Pronouns (optional)

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* 4. Race and/or Ethnicity (optional)

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* 5. Gender Identity (optional)

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* 6. Age

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* 7. Email

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* 8. Phone Number

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* 9. Home Address

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* 10. City and State

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* 11. Zip Code

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* 12. School Attending Fall of 2019

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* 13. School Grade Level Starting Fall of 2019

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* 14. Parent or Guardian First Name

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* 15. Parent or Guardian Last Name

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* 16. Parent or Guardian Email

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* 17. Parent or Guardian Phone Number

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* 18. Can you attend the workshop all five days (from July 22nd to July 26th) from 10 am to 3 pm? It's a requirement to be able to fully participate in the whole workshop.

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* 19. Have you applied to the Take Action Workshop in previous years?

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* 20. How did you learn about the Take Action Workshop?

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* 21. What local and/or global issues are you passionate about?

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* 22. This workshop will have a focus on Amplifier's We the Future campaign. Why would you like to participate in this workshop? (150 words max)

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* 23. What is something you would like to do to improve your school and/or community? (150 words max)

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* 24. Tell us about what you enjoy to do (hobbies, favorite school subjects, after-school activities, games, reading, etc.). (150 words max)