Join the Young Adult Alliance Today
Today's Date (00/00/0000)
First Name
Last Name
Company/ Organization
School/ University
Organization Affiliations
Are you a Kids In Action Graduate?
Yes
No
Unsure
Phone
Email Address
Age Group
18-21
22-25
25-30
31-40
Ethnicity
Town
Zip Code
Current Housing Situation
I live with my parents
I live on campus
I rent an apartment
I rent a house
I own an apt/ townhouse
I own a house
I live alone
I have roomates/housemates
Desired Living Situation
I want to rent an apt/ townhouse
I want to rent a house
I want to own an apt/townhouse
I want to own a house
I want to live alone
I want to live with others
Employment
I work Full-time
I work Part-time
I am a Full-time Student
I am a Part-time Student
I am Unemployeed
How do you Commute?
I drive a Car
I drive an SUV
I drive a Hybrid
I take the Train
I take the Bus
I Walk
I ride a Bike
I drive Other
If convenient, would you be willing to
take a Bus?
take a Train?
take a Subway?
take another form?
Are you registered to vote?
Yes
No
Unsure
Would you like to be a YA Leader?
Yes
No
Maybe
Task Force Interests
Energy and Environment
Small Business & Econ. Development
Healthcare
Housing and Development
Transportation
Young Adult Outreach
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