Academy for Young Leaders Student Application 2019-2020
Sign in to Google to save your progress. Learn more
Last Name *
First Name *
Middle Initial
Name You Prefer To Be Called *
Mailing Address *
City *
State *
Zip *
Phone Number *
High School *
Current Grade *
Gender *
T-Shirt Size *
Date of Birth *
eMail Address *
Please double-check for accuracy.
Parent/Guardian's Name *
Parent/Guardian eMail *
I understand that I am committed to attend the Fall ACADEMY FOR YOUNG LEADERS retreat on November 9th and 10th, and that I will actively participate in the monthly general and mentor group meetings and projects. I further understand that our AYL Group Project will be to plan and implement a Peer Pressure prevention program for middle school students. I realize I must attend 60% of the meetings to graduate, and 80% to reapply for a second or third year.
Student Signature Section *
By selecting "YES", I understand and agree to follow all requirements as stated above.  I also understand that ALL communication will be handled through email.  
Parent/Guardian Signature Section *
By selecting "YES", I understand the requirements of commitment as stated above and give permission for my son/daughter to participate (if selected).   I also understand that ALL communication will be handled through email.  
Applications must be completed and received by Friday, September 27th. All information received will be used for AYL selection purposes only. An anonymous selection committee will choose a diverse membership with varying backgrounds and leadership experience and/or potential. Notification of acceptance will be emailed no later than October 4th.
Clear form
Never submit passwords through Google Forms.
This form was created inside of Daviess County Public Schools. Report Abuse