Adult Referral, YLI 2019
Youth Leadership Initiative (YLI) Adult Referral
Each YLI student application must be accompanied by an adult referral (non-relative). This referral provides another perspective on the student’s potential for growth in the YLI program. Your support of this student is appreciated.

Please be thorough and help us to get to know the student. We appreciate your time completing this.

Please note: The adult referral must be received by the application deadline of April 22, 2019 for the student application to be deemed complete and eligible for program consideration.

Referral Full Name *
Your answer
Position/Title
Your answer
Organization
Your answer
Mobile Phone Number *
Your answer
Email Address *
Your answer
Student's Name (Applicant) *
Your answer
Relationship to applicant *
Your answer
How long have you known the applicant? *
Your answer
The YLI program is seeking students with plenty of room to grow! Participants who gain the most from YLI are:
• Eager to learn about their community and how they can shape its future
• Enthusiastic about building professional skills and gaining exposure to possible career paths
• Open to exploring their leadership potential, perhaps having had few previous opportunities
• Sincere about forming connections with fellow students and mentors from across Greater Des Moines
1. Tell us why you feel the applicant is a good fit for the YLI program based on the type of student we are looking for (see above). *
Your answer
2. What would you like to see the applicant improve upon or gain from the YLI Program? *
Your answer
Nomination: By submitting this complete form, I nominate the youth listed on this application for the Youth Leadership Initiative. I understand that this is an interactive, hands-on experience aimed at youth who are beginning to show leadership potential and an interest in the community. I certify that I am not related to the student whose name appears on the application.
Signature *
Your answer
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