Amachi Pittsburgh Youth and Family Application

Please complete a separate application for each child enrolling in Amachi programming. The following application will allow Amachi Pittsburgh to gain valuable information about the child and their life experiences. We appreciate your cooperation in answering all questions to the best of your ability.

Please answer the following questions about the YOUTH.

To which Amachi program is the youth applying? *This question is required.

Mentoring (6-18 years old)
Amachi Ambassadors - Teens
Learn & Earn – Summer Work Immersion Program – Teens
Youth Justice Advisory Board - Teens
Family Strengthening – Adults (Parents/Guardians/Caregivers)

Youth's First Name *This question is required.

Youth's Last Name *This question is required.

If the Youth has a preferred name or nickname, please list it here.

Youth's Date of Birth *This question is required. This question requires a valid date format of MM/DD/YYYY.

calendar

Youth Pronouns (e.g. He/Him, She/Her, They/Them, etc.) Select all that apply. *This question is required.

She/Her/Hers
He/Him/His
They/Them/Theirs
Other

If you said other, please specify.