Youth Leadership Institute Application Deadline: April 26, 2013
Fields marked with an * are required
First Name: *
Middle Name: *
Last Name: *
Preferred Name: *
Date of Birth: *
Age *
Gender *
Race
Guardian Names: *
Address: *
City: *
State: *
Zip Code:*
Telephone: *
Email Address: *
T-Shirt Size: *
Name of School: *
Grade: *
Principal's Name: *
Principal's Phone Number: *
Guidance Counselor: *
Homeroom Number:
Grade Point Ratio (GPR): *
In the boxes below, please list each applicable activity along with the dates you performed each activity. Please enter only one activity per line.
Extracurricular Activities*
Leadership Activities*
Jobs you have held (part-time, full-time or summer employment)*
Please Complete the Following Essay Question *
Why should you be selected to participate in the Youth Leadership Summer Institute?(150 - 200 words maximum) It may be useful to first write your response in a word processor then paste it here.
RecommendationsPlease submit one recommendation from a guidance counselor and one recommendation from a teacher, activity sponsor, or supervisor who is familiar with your interests and extra-curricular or volunteer activities. Download the recommendation form here.
By submitting this application, you are indicating that you will make yourself available for the 2013 camp from June 3-7. You are acknowledging that you understand that you cannot make other commitments for this time period.