Courage Callback Priority 1 Banner

Note: For Courage Retreats (our full-day program) click here for your Priority One form.

Required fields are marked with *, please fill out all these fields before submitting. If you still experience problems, print out your completed Priority One Form and fax it to Youth Frontiers at 952.922.2122. If you have any questions, please call the Retreat Coordinator at 1.888.992.0222. Thank you--we are looking forward to working with your students!

*Required Information

School Information

School Name*

School Address*

City*

State*

Zip*

How many schools will participate in the program?
If more than one, please list the schools attending.

In an effort to share our work with others, would you allow visitors to attend your retreat? (potential donors, principals, teachers, etc.)*

Yes No

Are you okay with media visiting to report on the retreat?*

Yes No

Will you allow Youth Frontiers to submit a press release regarding your retreat?*

Yes No

If so, please provide a short testimonial that can be included in the press release. (e.g. "Our school uses Youth Frontiers because...")

Contact Information

Note: The contact information entered should be for the person you would like Youth Frontiers to contact for program logistics (i.e., the person at your school who will be handling the details).

First Name*

Last Name*

Title*

Work Phone*

Fax*

Alternate Phone* (cell or home number)

Work E-Mail*

Second Contact Name

Second Contact Title

Second Contact Work Phone

Second Contact E-Mail Address

Courage Callback - Program Information

Note: The program is a 50 minute (one class period) presentation by Youth Frontiers.

Program Date*

Program Start Time*

Program End Time*

Grade(s)*

Number of Students (Maximum of 175 students per group)*

Location Information

Note: The Courage Callback is typically held at your school. We recommend holding this program in an enclosed space where all participants can be seated comfortably (i.e., your school auditorium or gymnasium).

Please describe the room you will be holding the program in (gymnasium, media center, etc.)*

(Optional) Enter anything our Retreat Staff should know about getting to your school (best door to enter, detailed driving directions, parking information, etc.)

Additional Information

Are there any school policies we should be aware of the day of the program? (e.g., cell phones, hats, iPods/earphones)
If yes, please explain.

Is there any additional information Youth Frontiers should know to best serve you?

What is the name of your community newspaper?

We appreciate your commitment to fund this program, and we'd like to use your wisdom to help other schools as well. How is your school funding this program? How could Youth Frontiers be a resource for your school in finding program funding?

Thank you for taking the time to complete the Priority One Form for your Courage Callback!

If you have any questions, please contact the Retreat Coordinator at 952.922.0433 or toll free 1.888.992.0222.

Submit your form by clicking the button below. Thank you!