University of YOUTH POWER! 2019

Registration Info
Please list any required disability accommodations.
Please list all allergies and special dietary needs.
Will you be bringing a support person? (A support person must be medically necessary or an accommodation you use in every day life to attend the event).
Roommate requests are subject to approval and not guaranteed.
Would you like to become a member of YOUTH POWER!?

I verify that this form is being filled out by the person who is registering to attend UYP, either on their own or with assistance.
 

I agree to appear in audio, video or print media for public relations, advertising, web development, commercial productions, documentaries, educational broadcast presentations, as well as any other forum to the benefit of YOUTH POWER! and Families Together in NYS. I understand that YOUTH POWER! and Families Together in NYS will have ownership of all recorded materials and I agree that YOUTH POWER! and Families Together in NYS may use my image and voice in any manner. I understand and agree that YOUTH POWER! and Families Together in NYS has the right to reproduce and distribute these materials and that I will not receive any form of compensation.

Code of Conduct: I have chosen to attend this event and will participate in discussion and activities. I will help to create a youth peer community based on mutual respect and a sense of personal well being. I agree to refrain from sexual behavior and public displays of affection while attending the YP! event. I will not bring or use any weapons, firearms, or anything that may be construed as a weapon. I will not possess, use, or distribute any illegal drug or drug paraphernalia. I will not commit any illegal act. I will treat others with honor and respect. Signed (type your name),
Event Fee
Resident students stay overnight on campus throughout the event. Day students commute individually to campus for classes and activities.
Total Fee(s)
Credit Card Information
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Billing Name and Address
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Annual Leader's Dinner

What are your top three advocacy issues you wish to raise with state government officials at the Leader's Dinner?
If there are any tables you DO NOT want to be seated at, please indicate below.
Help us know more about the diversity of UYP! Students.
 
 
 
Rate your level of expertise in Peer, Systems and Recovery Advocacy from 1 (new to the field) to 5 (very experienced).
    
Rate your level of knowledge on the following topics from 1 (no knowledge) to 5 (very knowledgeable)
    
  
 
Have you been in a residential placement such as a residential treatment facility, community residence, foster boarding home, kinship foster home, or rehabilitation center?