YouthBuild Information Session Sign Up

Thank you for your interest in YouthBuild Just A Start!

At our information sessions, you will learn more about our program structure, student support services, and the application process.

Please fill out the personal information below, or if pre-filled, update any information that is incorrect or updated. Choose the date and time that works for you to attend these in-person sessions which are located at 430 Rindge Avenue, Cambridge, MA 02140

If you have any questions, please email Tom Rodriguez at thomasrodriguez@justastart.org or call/text (617) 918-7528.

*Indicates Required fields

Applicant First Name

Applicant Last Name

City

Applicant Email

Applicant Date of Birth MM/DD/YYYY

Applicant Mobile

I agree to receive calls and SMS/MMS messages from Just A Start
to the mobile number I provided. Msg & Data Rates May Apply. Text STOP to opt out.

YesNo

Gender

Preferred Pronouns

He/Him/HisShe/Her/HersThey/Them/TheirsOther

If Other, please enter your pronouns here

Which session will you attend?

Choose a Session Date

How did you hear about us?

Hold control and click to select multiple items.

Please provide Name of person who referred you. If they are a staff member of an organization, also include their Title and where they work if you know it.

If Other, please explain

If you are filling out this form for someone else and you also want to be contacted directly, add Your Name & Your relationship to applicant, along with your contact information in the NOTE box below.

Notes

Contact ID

Contact Information