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Building Brotherhood, Confidence, and Leadership

Your answers help us create a space where every young man feels seen, heard, and supported. Take a moment to share your thoughts below. We can’t wait to grow with you this year.

First Name*

Last Name*

Parent's Email*

Age*

What is the name of your school?*

What state is your school in?*

What grade are you in?*

3rd

4th

5th

6th

7th

8th

How excited are you to be part of this program? (1 = Not excited, 5 = Very excited)*

1 - Not Excited

2

3

4

5 - Very Excited

How are you feeling about the program instructor so far? (1 = Unsure, 5 = Very positive)*

1 - Unsure

2

3

4

5 - Very Positive

How confident do you feel about sharing your ideas in a group? (1 = Not confident, 5 = Very confident)*

1 - Not Confident

2

3

4

5 - Very Confident

Which value do you most want to grow in during this program? (a) Belonging (b) Respect (c) Confidence (d) Awareness (e) Leadership*

Belonging

Respect

Confidence

Awareness

Leadership

What do you hope to get out of this program? (Open-ended)*

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Contact Us

495 Flatbush Avenue Brooklyn, NY 11225, USA

Follow Us On

Phone: 347-708-9077

Email: support@theboysroom.org

© 2023 The Boys' Room | All Rights Reserved

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