Youth Program Application

First Name

Last Name

Name You Prefer to be Called

Preferred Pronoun

Birthdate

mm-dd-yyyy

Ethnicity

School Name

Grade in School

GPA

Out of (highest possible GPA)

Student Email

Home Address

City

State

Zip Code

Cell Phone Number

How did you hear about the Youth Program?

Select desired week:

(Week 1) July 27 – July 31, 2020

(Week 2) August 10 – August 14, 2020

Parent/Guardian Email

Parent/Guardian Address (if different)

City

Zip Code

State

Cell Phone Number

Relationship to student

Why are you interested in this program? What do you hope to gain from it?

100 word limit

Describe an individual whose leadership style or skills you admire. How have you been influenced by this person?

100 word limit

How do you spend your time outside of school studies?

100 word limit

What is the most important thing you would like to share about yourself?

100 word limit

Signed (applicant)

Parent/Guardian: I give my permission for my child to participate in the Leadership Arlington Youth Program. Upon notification of acceptance into the program, I understand that Leadership Center for Excellence will notify my child and me of my child's acceptance into the Youth Program within two weeks of receiving my child's completed application and youth program reference form. At which time I will pay Leadership Center for Excellence the agreed-upon tuition fee within two weeks of acceptance. I also understand that scholarships are available, and no student accepted into the program will be turned away for financial reasons.

Signed (parent)

Youth Program Application

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