Chapter Name: Date Submitted:
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Chapter Demographics |
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Estimated percentage of Active/Core Members exposed to high-risk or under-served environments (i.e. below average academic
performance, not involved in extra-curricular activities, has exhibited behavioral problems in school, appears disconnected
from school, has negative self-valuation or low self-esteem, appears to have below average physical health, speaks English
as a second language, member of low-income family):
% of Total Active/Core Members |
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What languages, in addition to or other than English, are spoken by the young people and their families in your chapter?
(Check all that apply.)
Spanish
Chinese
Hmong
Vietnamese
Other (please specify) |
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Does the chapter membership reflect the gender and ethnic /cultural composition of the broader school population?
Yes, my chapter has the same racial and ethnic diversity of the broader school population.
No, my chapter is
more racially and ethnically diverse than the broader school population.
No, my chapter is
less racially and ethnically diverse than the broader school population.
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Chapter Activities |
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Will this chapter partner with any other groups?
Yes No
If yes:
Other youth groups
Parents
Law enforcement
Community members
Other partners
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