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Community Leadership on the Environment, Advocacy, and Resilience (CLEAR Miami) Program Application

To apply as a participant for CLEAR Miami, fill out this form below.  All fields are required.

Please contact Mayra Cruz at MayraC@catalystmiami.org or (786) 527-2573 if you have any questions.

Full Name

Your Email

Your Phone Number

Address

City/State

Zip code

Birthdate (Month / Day / Year)
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Gender
FemaleMaleNon-Binary

Are you a parent or guardian of children that would be interested in the youth class (ages 4-13)?
YesNo

If yes, how old are the children and what are their names?

Are you a parent or guardian of a teen that would be interested in the adult class?
YesNo

If yes, how old are the teens and what are their names? They should also fill out their own separate application.

Are you in need of transportation?
YesNo

Employment
Full-timePart-time
Other employment:

Occupation

Highest Level of Education Completed
College DegreeSome CollegeDiploma or GED
Other: Highest grade completed:

Race/Ethnic Background
Black/African-AmericanWhite/CaucasianHispanicAsian/Pacific IslanderAfro-Caribbean
Other race/ethnic background:

Are you affiliated with any organizations?
YesNo
If yes, please name them:

Briefly discuss an issue that concerns you most about climate change in our community (required)

What skills would you like to take away from our leadership program? What are your goals? (required)

Are there any challenges that would prevent you from completing the selected program? (required)

How did you hear about us (required)

Thank you for your answers and your interest in participating in CLEAR Miami!

To be included as a program participant, you must successfully complete a selection process. Filling out this application does not guarantee acceptance into the program. Catalyst Miami will be in touch with you regarding next steps. Thank you!