Workshop Application

First Name

Last Name

Home Address

City

State

Zip Code

Country

What school/group are you representing?

Phone (HOME)

Phone (CELL)

FAX

Title Of Workshop

For # of Participants:

Workshop Topic

Presenter is:

Please list names of all presenters

(All youth-led presentations must be planned and rehearsed before an adult sponsor who notfiys Youth to Youth that the presentation is properly prepared)

Attended a Y2Y Conference Before?

If Yes, please list conferences

Have you presented this workshop before?

If yes, where and for whom?

Knowledge/Skill Outcome (“At the completion of this workshop, participants will....”)

Skill/Outcome #1

Skill/Outcome #2

Skill/Outcome #3

AV Equipment Needs

List Materials Needed: Workshop materials must be provided by the presenter unless prior arangements are made with Youth to Youth

Materials Needed:

Workshop Desrciption (20-30 words to be used on Workshop Descritption sheet for participants. Be creative!

Workshop Description

Please list the conference for which you are applying. If applying for more than one, please rank by 1st, 2nd, and 3rd

International's Conference

Western States Conference

Eastern States Conference

I agree to promote only a drug-free choice for teens in my workshop.

Please initial, if yes:

Please email a Summary/outline of your workshop presentation. Please be detailed and specific, including an agenda with time breakdowns, activity descriptions, goals and/or purpose of activities, and processing questions. Please attach a copy of all handouts that will be distributed. Send to