Register Teens for Outreach

Teenagers Outreach Registration

Thank you for participating in our outreach program. Please complete this form accurately.

Personal Information

1. Full Name *

2. Gender *

Male Female

3. Age *

4. Phone Number (if available)

5. Parent/Guardian Phone Number *

6. Home Address/Community *

Educational Information

7. What is your current educational status? *

Currently in Primary School Currently in Secondary School Currently in Tertiary Institution Vocational/Skill Training Not Currently in School (Dropped Out) Never Attended School

8. Name of School/Institution (if applicable)

9. Current Class/Level (if applicable)

10. If you are not currently in school, what is the main reason?

Financial Challenges Family Responsibilities Health Issues Lack of Interest Relocation Other

Program Information

11. How did you hear about this outreach? *

Friend School Social Media Religious Organization Community Leader Other

12. Which area would you like support in? (You may select more than one) *

Leadership Development Academic Support Scholarship Opportunities Career Guidance Life Skills Confidence Building Entrepreneurship Spiritual Growth Other

13. Have you attended any of our programs before? *

Yes No

14. What is one challenge you would like us to help you overcome? *

15. If educational support or scholarship opportunities become available, would you like to be considered? *

Yes No

Raising Influential Leaders — Empowering disadvantaged teenagers to build a brighter future through mentorship, education, and opportunity.

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Programs

Mentorship Counselling Scholarship Vocational Training

Contact Us

Ajah, Lagos, Nigeria

hello@rachealandteens.org

+2347037560986