Boys to Men Leadership Academy Application
CONNECT TO GREATNESS, INC | Electronic Academy Application

Note: The participant should complete the application. Please answer the following questions as completely as possible. This information will help us to recruit the right coach(es) for you.

INCLUDE A LETTER OF RECOMMENDATION FROM A TEACHER, COACH, COUNSELOR ETC., WITH THIS APPLICATION. Recommendation link: https://docs.google.com/forms/d/1xnpQyKpCnSDL9lvwAeANosGPS1SDGGiPt_SBD-JP_LQ/edit

Today's Date
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First name
Your answer
Last name
Your answer
Street Address
Your answer
City
Your answer
State
Your answer
Zipcode
Your answer
Telephone Number
Please enter a telephone number for the parent and youth into this box.
Your answer
Parent Name
Your answer
If you are not living with your mother or father, who is your legal guardian?
Your answer
Name of Guardian
Your answer
Guardian Relationship to You
Your answer
How many brothers do you have
Your answer
Brothers age(s)
Your answer
How many sisters do you have
Your answer
Sister age(s)
Your answer
My favorite kind of music is
Your answer
My favorite television show is
Your answer
My favorite sport is
Your answer
My best subject in school is
Your answer
My worst subject in school is
Your answer
Do you have any after-school responsibilities (Yes or No)
Your answer
If yes, what are your after-school responsibilities
Your answer
Describe your special interests and hobbies (e.g. sports, arts & crafts, computers/technology, music, reading, cooking, games, career interests, foreign languages, painting, reading, etc.)
Your answer
What clubs or groups do you belong to
Your answer
What do you like to do most with your free-time
Your answer
How could a "coach" help you
Your answer
What do you hope to get out of your coaching relationship
Your answer
Is there anything that you would like to share with your coach
Your answer
What would you like to do with your coach
Your answer
Why are you interested in participating in this program
Your answer
AGREEMENT: I agree that I will meet with my coach and/or my group at the times and locations arranged between us. I also agree to notify my coach and/or other adult in-charge if I am unable to make a weekly meeting. By entering my Youth Name and Email address I accept that this my electronic signature for C2G. By entering Parent/Guardian name and Email address I accept this as electronic signature for C2G. I give permission for my son to participate in the Connect to Greatness Boys to Men Leadership Academy program and activities. I understand that my son will be expected to follow the set rules and expectations of the program at all times. (Select YES or NO)
Youth Signature Agreement
Your answer
Youth Email Address
Your answer
Parent/Guardian Signature Agreement
Your answer
Parent/Guardian Email
Your answer
Parent/Guardian Email
Your answer
I understand that during some activities/discussion, my son may be exposed to discussions that are sensitive. I understand that I am responsible for communicating to the leader and adult-in charge about any needs that my child may have in regards to any activities/discussions. I am confident of his maturity and ability to participate. (Select YES or NO)
1st Emergency Contact Name
Your answer
1st Emergency Contact Number
Your answer
2nd Emergency Contact Name
Your answer
2nd Emergency Contact Number
Your answer
3rd Emergency Contact Name
Your answer
3rd Emergency Contact Number
Your answer
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