SOC Enrollment Form

Please answer the following questions to help us understand your role, experience, and background. This information will help us connect peers within the cohort.

Please let us know of any dietary preferences or food allergies we should be aware of.

Center for Safe Alaskans' program, the Anchorage Youth Development Coalition, needs permission to use a person’s photograph, voice, and/or name in various media projects. This is necessary for projects that produce a form of media, like photos or videos, which may be a product of the project or necessary to share the story of the initiative. For and in consideration of the opportunity and privilege of appearing in or participating in one or more video or audio recordings, sound tracks, films, photographs, or written articles, I hereby consent to the use and editing thereof and release the Center for Safe Alaskans and its Anchorage Youth Development Coalition employees and assignees from any and claims resulting from such use and editing in media, and use, sale, editing and release to the newspapers, radio and television stations; and use on the Internet.