Fairfax County Youth MOVE (FCYM) Application

Do you have experience navigating social services or mental health services OR have you needed services and not been able to access them? Do you want to use these experiences to educate professionals, advocate with program designers, and empower other young people to share there stories?? Then Fairfax County Youth MOVE is the group for you!!!

We meet most Sundays @ 12:00 pm - 1:30 pm and the meetings are hybrid, so you have the option of joining online or coming to the JSSA office in Fairfax.

Chapter Members will be:

Given a stipend 12.77 an hour for meetings, trainings, and events
Compensated for childcare as needed
Assisted in accessing transportation

We are asking you to commit to an average of 10 hours a month for at least 6 months.

Applicants must be Fairfax County residents and between 14 and 22 years old.

Please Note: We are not evaluating this application based on your writing ability or grammar. At the end of the day, your perspective is what matters. The contents of your application will be kept confidential. If you have any questions or need any accommodations to complete the application, please contact MattyStewart-Boldin, Youth Development Coordinator, at mstewart-boldin@jssa.org.

Name

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

What is your prefered form of communication?

Other

If you chose other, please enter the details below

Date of Birth

Date

What is your gender identity?

What pronouns do you use? (ex: she/her/hers)

What is your primary language?

Do you identity as LGBTQIA+?

What is your racial identity? (Check All that Apply)

Do you identify as Latino/a/x or Hispanic

Do you identify with another non-Latino ethic group?

What best describes you? (Select all that apply)

If applicable, what school, university, or trade program are you enrolled in?

Do you have any experience navigating the following systems? Please check all that apply.

Optional: If you want to share anything else about your experience with programs or systems, please share here.

What do you consider some of your skills and strengths? (1-3 sentences recommended)

Note: Please do not use AI to complete this question.,

What is one thing you would like to change about the agencies and organizations that serve youth and young adults? (1-3 sentences recommended)

Note: Please do not use AI to complete this question.,

We want to make sure we set you up for success. We understand that personal well-being is important and should be a priority. With that in mind, would you be comfortable sharing a bit about where you are in your recovery journey and what type of a support system you have in place? Understanding this will help us ensure you have the best possible experience. (1-4 sentences recommended)

Note: Please do not use AI to complete this question.,

Do you feel comfortable sharing your experiences for advocacy?

Other

Is there anything else you would like to share about yourself that was not covered in these questions?

Note: Please do not use AI to complete this question.

Do you need a language interpreter/translator?

Other

Fairfax County Youth MOVE (FCYM) Application

Demographics

School and Work

Lived Experience

Open-Ended Questions