SOC Enrollment Form

This form is to be completed by each person participating in SOC main cohort.

Second Order Change Enrollment Form 2023


Your Role

Please answer the following questions to help us understand your role, experience, and background. This information will help us connect peers within the cohort.
1. Roughly how many years of work experience do you have in organizations and/or roles like the one you are in now?(Required)
3. In your role, do you work primarily with youth or adults?(Required)
4. If you work with youth, what is the age of MOST of the youth you work with?(Required)
5. Do you supervise staff?(Required)
6. Do you make policy and/or strategy decisions for your organization?(Required)
7. In what setting does your organization work with youth MOST of the time?(Required)
8. Roughly how many paid staff members (full-time and part-time) work at your organization?(Required)

Dietary Preferences

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

Media Release

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.
I agree with the media release.(Required)
Fee Payment
Payment Method
Supported Credit Cards: MasterCard, Visa