2015 SAFE SCHOOLS YOUTH SUMMIT APPLICATION

Names of Participants (3-5)

Include only student participants

First Name

Last Name

First Name

Last Name

First Name

Last Name

First Name

Last Name

First Name

Last Name

School

Primary Contact Phone Number

(###)

###

####

Primary Contact Email Address

Faculty Sponsor

First Name

Last Name

What are the most important bullying issues that need to be addressed at your school?

How do you think your group can help your school end bullying?

Why does your group want to be a part of the Safe Schools Youth Summit?