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Program Enrollment (Individuals)

Full Name

*

Email

*

Phone Number

*

City or Community

*

Age Group: Which option best describes you?

*

Age Group: Which option best describes you?

A

Youth (under 18)

B

Young Adult (18–24)

C

Adult (25+)

D

Parent or Guardian enrolling a youth participant

Which program are you interested in participating in?

*

Which program are you interested in participating in?

Cultural education workshops

Youth mentorship participation

Dialogue circles or conflict resolution facilitation

Community training programs

Cultural humility training

Survivor support through the Tlazolteotl Coalition

I am not sure yet and would like guidance

When are you generally available?

*

When are you generally available?

Weekday evenings

Weekends

Flexible

How did you hear about Teyolia?

A

School or educator

B

Community organization

C

Social media

D

Friend or family member

E

Community event

F

Other

Is there anything you would like us to know about your interest in this program?

I understand that submitting this form does not guarantee immediate enrollment and that a member of the Teyolia team will contact me regarding program participation.

*

I understand that submitting this form does not guarantee immediate enrollment and that a member of the Teyolia team will contact me regarding program participation.

Yes