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Youth Resource Guide Submission


Youth was clearly a high priority identified during the City of Palmdale's recent Strategic Planning process. In particular, youth and their parents discussed the lack of a central resource to locate services and activities. In response to this concern, the City of Palmdale is initiating a Youth Resource Section of its Web site. If your agency or business provides a service, utilizes volunteers or facilitates activities for youth (ages 0-24), we invite you to submit your information for inclusion in the Youth Resource Guide. Simply complete the following survey and your organization will be reviewed for inclusion in the guide. Please note, inclusion in the guide does not connotate endorsement by the City of Palmdale for any program or activity.

If you have any questions regarding the guide or need assistance in completing your survey, please contact us at youthguide@cityofpalmdale.org, or call 661/267-5400.


The Youth Resource Guide is provided by the City of Palmdale as a service to the community. Inclusion in the guide is voluntary and conditional upon City approval. The City is not responsible for the accuracy of the information provided by participating organizations and users are advised to contact the agency/organization directly for direct information. Please note, inclusion in the guide does not connote endorsement by the City of Palmdale for any program or activity and an organization may not use inclusion in the guide as an endorsement of the program for purposes of funding or collaboration.


* = Required Field

Please use only letters and numbers, commas, periods or apostrophes in the form fields.
Other special characters will not be allowed.


* Agency Name:


Mission Statement:


* Agency Contact Name: (for City staff use only)


* Program Contact Name: (for applicant contact)
* E-mail Address:

 * Confirm E-mail Address:
* Program Location Address:
Agency Web Site:
* Agency Phone Number:

 Agency FAX Number:
Program Phone Number: (if different)


* Agency Type:
Non Profit
For Profit
Other:
Nationwide/Local Affiliate: (optional)
Yes
No
Parent Organization (if applicable)
*Program Title
*Program Description:
(500 characters maximum) characters left
* Program Category: (Select all that apply)
Animals/Agriculture
After School Program
Arts/Entertainment
Conflict Resolution
Drop In Center
Education/Tutoring
Job Skills Training
Family Support
 Life Skills
Religious Affiliation
Recreation
Social Interaction
Sports
Transportation Services
Violence Intervention
Other:
* Cost: (only choose one option - list the amount that is charged)
No Cost
Per Session Fee
One Time Enrollment Fee
Weekly Fee
Monthly Fee
Annual Fee
Other
* Terms of Enrollment: (please check all that apply)
Calendar Year Based
School Year Based
Weekdays (M-F)
    Check days: M
                       T
                       W
                       TH
                       F
 Daily (Weekends
           and Weekdays)
Weekends (S-S)
Time Specific
Scheduled Sessions
Open Enrollment/Drop In
        Anytime
Other:
* Eligibility: (only choose one option, please specify requirements where necessary)
No Requirements
Pre-requisites:
Referral Required:
Previous Class Completed:
Skill Level:
GPA:
Residency:
Other:
Age Based: (Select all that apply)
N/A - All Ages
0-5 years of age
6-10 years of age
11-13 years of age
13-15 years of age
16-18 years of age
18-25 years of age
Other:
Grade Based: (Select all that apply)
Not Applicable
Infant to Toddler
Preschool
Elementary
Intermediate/Junior High
High School
College/Post H.S.
* Program Hours (List Specific Program Hours):
* Do you cater to a specific target group or demographic?
Yes
No
If yes, please specify:

Volunteer Information:
* Are there any opportunities for youth volunteers with your program?
Yes
No

If yes, please identify program contact:


Phone:


Minimum Age: (with parent volunteer accompaniment):


Minimum Age: (independent service, i.e., without parent accompaniment):


Volunteer days: (check all that apply):
S
M
T
W
TH
F
S

Is training required?
Yes
No

If yes, please specify:

* Are there any opportunities for adult volunteers with your program?
Yes
No

If yes, please identify program contact:


Phone:


Volunteer days: (check all that apply):
S
M
T
W
TH
F
S

Is training required?
Yes
No

If yes, please specify:

* Do you accept Court Ordered Community Service?
Yes for Adults
Yes for Youth
No

Would you like your program application available on the City of Palmdale Web site? If yes, please provide a link to your online application.

Or, you may submit your application form to us in either MS Word or PDF format.
Please e-mail as an attachment to: youthguide@cityofpalmdale.org

      
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