Academy for Young Leaders Student Application 2017-2018
Last Name *
Your answer
First Name *
Your answer
Middle Initial
Your answer
Name You Prefer To Be Called *
Your answer
Mailing Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Phone Number *
Your answer
High School *
Current Grade *
Gender *
T-Shirt Size
Your answer
Date of Birth *
Your answer
eMail Address *
Please double-check for accuracy.
Your answer
Parent/Guardian's Name *
Your answer
Parent/Guardian eMail *
Your answer
COMMITMENT DETAILS
I understand that I am committed to attend the Fall ACADEMY FOR YOUNG LEADERS retreat on November 4th and 5th, 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.
DEADLINE
Applications must be completed and received by Friday, September 15th. 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 September 25th.
Next
Never submit passwords through Google Forms.
This form was created inside of Daviess County Public Schools. Report Abuse - Terms of Service - Additional Terms