Youth Leadership Program Application
First Name *
Your answer
Last Name *
Your answer
Gender *
School *
Your answer
Grade *
Your answer
Email *
Your answer
Home Address *
Your answer
City *
Your answer
Zip *
Your answer
Home Phone *
Your answer
Cell Phone *
Your answer
Community Activities *
In what school or community activities are you involved, and which one gives you the most satisfaction and why?
Your answer
Previous Applicant *
Have you previously applied to the Youth Leadership Program sponsored by the Future Foundation?
Conflicts *
Do you have any conflicts that will prevent you from participating in all of the sessions which will take place on Wednesday afternoons from 4:00-5:30? (See information sheet for specific dates.) If so, please explain.
Your answer
Program Interest
The 10 week curriculum will include sessions on Leadership, Local Government, Law Enforcement, Health Programs, Recreation, Education, Community Services, and Business. Write a short paragraph, (200 words maximum per question), in answer to the following four questions.
What do you hope to get out of the program? *
Your answer
How do you personally define leadership, or what characteristics or qualities do you believe positive leaders need to possess? Additionally, what leadership traits do you need to develop and why? *
Your answer
What does being a role model mean to you? Describe how you have been a role model to other students. *
Your answer
What obstacle have you had to overcome? *
Your answer
If accepted into the program, what roles are you likely to take on? *
Required
Agreement *
My child has my permission to attend the Youth Leadership Program. I understand that transportation is not provided and that community service credit is based on attendance. Conejo/Las Virgenes Future Foundation reserves the right to use photos/video taken during activities/programs for publicity purposes. Supervision is only provided during meeting times, from 4:00 p.m.- 5:30 p.m.
Required
Parent Name *
First & Last Name
Your answer
Parent Email *
Your answer
Parent Phone Number *
Your answer
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