Forms • Lewiston, ME • CivicEngage

HUMANKIND = KIND HUMANS . . . BULLYPROOF LEWISTON

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The Lewiston Youth Advisory Council (LYAC) has been running a "Shine on Lewiston" series highlighting all the positives in Lewiston. Taking a bit of a turn, the group has now decided to "shine a light" on an important issue that is all too common in today's world--that of bullying. WHAT IS YOUR STORY? PLEASE NOTE: This form is not meant to "bully" anyone back nor list specific people's names.
LYAC is seeking individuals who would like to "share their story" about the bullying they've encountered for a video that LYAC will be producing. WOULD YOU like to be considered for LYAC's video? It is entirely LYAC's discretion as to which stories are selected for video inclusion.*
If interested, what is your name?
What is a contact phone number for you?
What is an email address by which LYAC can contact you?
If used in the video, I understand that a release form would need to be signed by myself or my parent/guardian (if I'm a minor). *
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