Academy for Young Leaders Student Application 2016-2017
Last Name
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First Name
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Middle Initial
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Name You Prefer To Be Called
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Mailing Address
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City
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State
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Zip
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Phone Number
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High School
Current Grade
Gender
T-Shirt Size
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Date of Birth
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eMail Address
Please double-check for accuracy.
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Parent/Guardian's Name
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Parent/Guardian eMail
Your answer
COMMITMENT DETAILS
I understand that I am committed to attend the Fall ACADEMY FOR YOUNG LEADERS retreat on November 19th and 20th, 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 16th. 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.
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