BRITE Future Initiatives
Our BRITE team is dedicated to serving Ventura County residents currently enrolled in local high schools or middle schools. Our primary mission is to empower you to drive meaningful change within your community. This application will gather basic information about you for reporting purposes and include a brief pre-survey to assess your knowledge on relevant topics.
First Name
*
Last Name
*
School:
*
What best describes your ethnicity/race?
*
Asian
Black or African American
Hispanic or Latino/a/x
Native American or Alaska Native
Native Hawaiian or Other Pacific Islander
White
Multiracial
None of the above/prefer not to answer
What are your pronouns?
Date of Birth
*
-
Month
-
Day
Year
Date
If selected multiracial or none of the above, please specify:
What’s the best way to contact you?
*
Please Select
Email
Text
Phone Call
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Back
Next
Please answer the survey honestly based on your current knowledge.
How aware are you of the problems people in your community are facing?
Not Aware
1
2
3
4
Aware
5
1 is Not Aware, 5 is Aware
How confident do you feel about getting involved and making a difference in your community?
Not Confident
1
2
3
4
Very Confident
5
1 is Not Confident, 5 is Very Confident
How would you rate your understanding of the risks associated with substance use?
Not Knowledgable
1
2
3
4
Very Knowledgeable
5
1 is Not Knowledgable, 5 is Very Knowledgeable
How connected do you feel to the community you live in?
Not Connected
1
2
3
4
Very Connected
5
1 is Not Connected, 5 is Very Connected
Why are you interested in participating in the BRITE Future Initiative's program?
Would you like to learn more about volunteer opportunities with our county-wide Youth Coalition?
Please Select
Yes
No
Maybe
Submit
Should be Empty: