2017 Youth Leadership Academy Application
Please complete all sections in this application. If you have any questions, please feel free to contact the Delaware County Chamber of Commerce at 610-565-3677.

APPLICATION DEADLINE is March 6, 2017.

Criteria
Students interested in applying for the Youth Leadership Academy must meet the following criteria:

Delaware County Resident
Currently enrolled in the 10th grade
Good academic standing
Involved in extracurricular activities
Interested in developing their leadership potential
Able to attend all 3 days of the Academy (April 24-26, 2017)

Section 1 Student Information
Name
Your answer
School Name
Your answer
Student Home Address
Your answer
City
Your answer
State
Your answer
Zip
Your answer
Student Email Address
Your answer
Parent Name
Your answer
Parent Email Address
Your answer
Home Phone Number
Your answer
Cell Phone Number
Your answer
Section II: Community Involvement
List any community service, school organizations, honors/awards, personal accomplishments, etc.
Your answer
Section III: Nominator Information
To be completed by the HS Guidance Counselor, faculty member or current Delaware County Chamber member.
Name
Your answer
School/Business Name
Your answer
Mailing Address
Your answer
City
Your answer
State
Your answer
Zip
Your answer
Email Address
Your answer
Work Phone Number
Your answer
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