Guest Application - Youth Mentoring and Personal Growth Resources

TeenSpeak- Guest

I would like to be a guest on your podcast, TeenSpeak- Empowering Today"s Youth

First and Last Name(Required)

Email Address(Required)

Cell Phone Number(Required)

Shirt Size(Required)

Current Grade(Required)

What school do you attend?

City & State

What would you like to share about your school?

What is your favorite course in school?

What song always makes you feel good?

This is a safe space, so if there is anything you are not comfortable speaking about, please let us know.

We appreciate and respect everyone's values, thoughts, and beliefs.

Is there anything specific that you would like to speak about?

This is where you can share a passion, concern or other agenda item that you feel would be beneficial, educational and advantageous for the listeners.

What would you want others to know about you?

This could be your interests, dislikes, favorite food, music, etc.

Guest Photo

Accepted file types: jpg, jpeg, png, gif.

This is optional

Consent Policy(Required)

I have read the policy and agree to its content

I hereby consent to the recording and distribution of reproduction(s) of my voice and video performance as part of the media program entitled TeenSpeak podcast. If under age 18, I have obtained parental permission to be a guest on TeenSpeak. Also this is to confirm that the undersigned has agreed to be interviewed or otherwise participate in the program, a production of TeenSpeak. As a condition of publication/broadcast and for no monetary compensation, TeenSpeak requests the non-exclusive worldwide rights to reproduce and distribute, your oral and/or video presentation, in whole or in part, in any media, as part of this Program published under the auspices of TeenSpeak. TeenSpeak shall have the right to edit and/or transcribe your presentation. You also grant TeenSpeak the right to use your name, biography and likeness in connection with the program.