OH-WV YMCA Past Participant Data Form

I f you have been a past participant of one of our programs or in some way have been involved with the Ohio-West Virginia YMCA as a volunteer, friend, supporter, or in whatever capacity, we'd love to hear from you. Please take a few moments to complete this data entry form and let us know about your involvement.

Your Name: First:
Middle Initial:     Last:
Maiden Name:
Mailing Address: Street:
City:
State:
Zip:
Phone:
E-mail Address: Primary:
Secondary:
Gender: Male: Female:
Are you Registered
on Facebook.com?		 Yes No
Year of High
School Graduation:
College Attended:
Year of College
Graduation:
Current Occupation:
Are you Active
in your Community?		 Yes No
If YES,
Please Explain:
HI-Y Involvement: HI-Y Name:
Name of School:
Advisor: Yes No
I was a Participant in: Ohio Youth in Government in year(s)
       Office Held:
West Virginia Youth in Government in year(s)
       Office Held:
Ohio Fall Conference in year(s)
West Virginia Fall Conference in year(s)
United Nations in year(s):
       Office Held:
I was at
Camp Horseshoe:		 Free Enterprise Leadership Camp in year(s):
HI-Y Leadership Camp in year(s):
Leadership-Service Camp in year(s):
Adventure Camp in year(s):
YOC Camp in year(s):
Other Program or
Camp Participation		 in year(s)
Haven't been a
Program Participant
but have been:		 Friend of the Leadership Center
Contributor
Volunteer
Tell Us What
You've Been Doing
or send us your
Comments/Questions:

Note: Your name, school, leadership position, participation dates and email address will be published on this site so that you may keep in touch with other Ohio-West Virginia YMCA friends.