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2021 Changemakers Institute Registration

To register for the 2021 YMCA Changemakers Institute, please complete the form below.

Late Registration:
 Late registration is open for a limited time until our final spaces are filled!

You will need to pay your registration fee using a credit card before you can submit this form. If you are unable to pay via credit card, please email nikkey@kyymca.org to request an alternate form of payment/registration!

Spaces are limited, and registration is first-come, first-served! Once we hit capacity, students will be added to a wait list. We will contact those on the wait list if spaces become available.
Participant Information







Please use a personal email (not a school account).










For graduating seniors,
Participant Demographics
This information is for demographic purposes only and has no bearing on your participation or involvement in our programs. Responses will remain confidential to Institute staff and are not analyzed on an individual basis.




Please describe
Career/Professional Interests



What kinds of positions/roles would you like to pursue within this field?
Social Media Use Survey
Which of these social media platforms do you use?






Virtual Code of Conduct
By adding your digital signature below, you agree to adhere to the Virtual Code of Conduct that can be found at www.ymcayag.org/virtual/conduct

Violations of this code - or the code of conduct from your own local/state YMCA programs - can result in your removal from participation in future virtual and non-virtual programming.


Please type your full name.
Parent/Guardian Information & Agreement




My parent/guardian agrees to my participation in the YMCA Changemakers Institute, and understands my commitment to upholding the Y's Virtual Code of Conduct. Violation of this Code of Conduct may result in my removal from the Institute without a refund of my registration fee.


Changemaker Cohort
During the Institute, you will be collaborating with other student participants as members of one of our 10 Changemaker Cohorts. These cohorts are organized by the following areas of focus: 

Tuesdays | 4:00-5:30pm ET
  • Education Reform & Student Voice
    Members of this cohort will address issues in their local communities related to our educational system, strengthening civics education, and increasing student representation and voice.
  • Gender Equity & LGBTQ Rights 
    Members of this cohort will address issues in their local communities related to increasing gender equity and elevating/advocating for LGBTQ rights.
  • Hunger, Homelessness, & Poverty
    Members of this cohort will address issues in their local communities related to decreasing and mitigating hunger, homelessness, and poverty, or ensuring access to clean water.
  • Mental Health
    Members of this cohort will address issues in their local communities related to the ever-growing mental health concerns facing individuals, families, and health care providers.
  • Youth Employment & Workforce Readiness
    Members of this cohort will address issues in their local communities related to increasing opportunities for youth employment and ensuring student readiness for joining the workforce.
Wednesdays | 4:00-5:30pm ET
  • Abuse & Violence Prevention
    Members of this cohort will address issues in their local communities related to preventing all forms of abuse and violence, including but not limited to: child abuse, sexual assault/violence, domestic abuse, and gun violence.
  • Climate Action & Sustainability
    Members of this cohort will address issues in their local communities related to promoting sustainable environmental practices, agricultural reform, and climate action/advocacy.
  • Physical & Sexual Health/Wellness
    Members of this cohort will address issues in their local communities related to promoting health and wellness, including chronic disease prevention, accessible healthcare, and sexual health.
  • Racial Equity & Justice
    Members of this cohort will address issues in their local communities related to increasing racial equity, uplifting diverse voices, supporting immigrant/newcomer populations, and elevating/advocating for justice.
  • Voting Rights
    Members of this cohort will address issues in their local communities related to ensuring and expanding voter outreach, voter registration, and access to voting.


Must be different than your first preference.

Must be different than your first or second preference.

All Institute participants will be working on a personal Changemaker Initiative addressing a local issue in their community related to their cohort's area of focus. If you already have a specific initiative in mind, please describe it above in 3-5 sentences. 
Cohort Captains
Each Changemaker Cohort will be led by two student captains. As captains, you'll facilitate 20+ peers in your cohort during your weekly meetings, supported by your Cohort Facilitator (YMCA Staff/Volunteer) and Cohort Specialist (professional with expertise in your cohort's area of focus).


Why do you want to serve as a cohort captain? What experience/skills could you bring to the role?
Payment Information
The fee for participation in our Changemakers Institute is $100. If you are unable to pay using a credit card online, please email nikkey@kyymca.org for other payment options.





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