LACE Membership

LACE Membership

Building our Community Through Education and Collaboration
Name

First Name Last Name
Email
example@example.com
Phone Number

Area Code Phone Number
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Race/ethnicity (mark all that apply)

White Black Latina Hispanic Asian African American Rather Not Share
Name of School
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Grade entering Fall 2020
Parent/Guardian Information
Name

First Name Last Name
Phone Number

Area Code Phone Number
Email
example@example.com
Place of Employment
Job Title
Directions: In 250-300 words answer the following question in the box provided below.
If you could change one thing about your community, what would it be and why?
What does empowerment mean to you? Do you have someone who empowers you in your life? Who? Why?
Shirt Size
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