Blackstone Valley Youth Leadership Academy Application 2020-2021
Each member high school will select their representatives for the 2021 BVYLA cohort. All candidates are asked to complete this application and submit electronically. Schools may have additional internal requirements such as letters of reference and interviews.

The BVYLA program runs November through April on specified Tuesday afternoons with a May graduation ceremony.
Name *
Date of Birth *
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High School *
Current Grade *
Phone where you can be reached *
Your email address *
Parent/Guardian Name *
Parent/Guardian email *
Home address including city, state, zip *
Home phone or parent phone *
How to reach parent/guardian in an emergency *
Alternate emergency contact name and phone *
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