Youth Vote Ambassador Application - New Jersey Institute for Social Justice

Register Here: Youth Vote Ambassador

Thank you for your interest in participating in the Youth Vote Ambassador Program. A full schedule and details about the program can be found at here.

Please complete this form to register.

For any questions or additional information, please contact Assatta Mann at amann@njisj.org.

About You

Name(Required)

First Last

Date of Birth(Required)

Home Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Email(Required)

School Name(Required)

Grade Level(Required)

Organization (if applicable)

Preferred Pronouns

PARENT/GUARDIAN INFORMATION (IF UNDER 18-YEARS-OLD)

Participants under 18 will be required to receive their parent or guardian’s permission to take part in the program. Submit your parent/guardian’s contact information and the New Jersey Institute for Social Justice’s staff will send them the necessary forms to complete on your behalf.

Parent/Guardian Name

First Last

Parent/Guardian Phone

Parent/Guardian Email

Program Participation

Why are you interested in participating in the Youth Vote Ambassador Program?(Required)

Which virtual workshops are you available to attend?

Wednesday, January 22, 2025 (6pm-8pm): Workshop 1: Out Vote, Our Power

Thursday, January 23, 2025 (6pm-8pm): Workshop 2: School Boards 101

Friday, January 24, 2025 (6pm-8pm): Workshop 3: Youth Power the Polls

Do you require any special accommodation to participate in this event?

Do you have any questions or concerns?