Youth Leadership Conference 2021
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Dear applicant,

Future Leaders of America, Inc. “FLA” – cordially invites you to apply to our Youth Leadership Conference for students residing in the Central Coast cities of Santa Maria, Santa Barbara, Carpinteria, Oxnard & Port Hueneme.

The challenging five - day program will take place:

August 2 - 6, 2021
Daily from 12 - 3 PM

Through our leadership training, we hope to challenge you in such a way that you will continue to strive for higher goals and continue on your path to excellence. The program will help you develop self-confidence, self-esteem, and valuable leadership skills. You will discover not only what it means to be a student leader but how to be a responsible citizen as well.

To be considered for the FLA Leadership Conference, you must meet the following requirements:

• Demonstrate a commitment to leadership and personal success.
• Have a grade point average of approximately 2.5 in your school coursework.
Please contact our Youth Organizer if you do not fulfill this requirement
• Submit a completed application

The application deadline has been extended to May 28, 2021, to ensure that all interested students have a chance to participate.

Once you have successfully completed the program, you will be a “Future Leader” and will be eligible for all FLA programs throughout high school and college. You will have access to a student network of over 8,000 alumni willing to mentor you through your high school and college careers. You will also have the opportunity to travel throughout California and attend university seminars at prestigious universities such as UCLA, UC Berkeley, and Stanford, and meet nationally recognized leaders. The opportunities abound for you in FLA are endless. Take the challenge and apply today!

We look forward to reviewing your application and meeting you personally in the near future. If you or your parents need additional information in English or Spanish, please give us a call at 805-642-6208, or e-mail at


Gabriela Macias-Mota
Program Director
Future Leaders of America
What FLA region are you applying for? *
Full Name (First Name, Middle Initial, Last Name) *
Date of Birth (mm/dd/yy) *
Age *
What is your gender identity?
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Do you identify as transgender?
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What is your sexual orientation? (select all that apply)
What is your ethnic identity? (select all that apply) *
Are you part of an immigrant community?
This includes people who are undocumented, Dreamers, mixed-status family members, legal residents, visa-holders, and/or naturalized citizens.
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Do you identify as Indigenous?
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If you identify as Indigenous, what tribal or national affiliation(s) do you associate with?
If you identify as Indigenous, do you identify as Two-Spirit or another similar identity?
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School you currently attend *
Grade Level *
School you will attend next year (if you are in 8th grade)
Home Address (include apartment number) *
City *
State *
Zip *
Student Phone Number *
Student Email *
Parent Phone Number *
Parent Email
Language(s) spoken at home: *
Mother/Guardian - Full Name *
Mother/Guardian - Highest Level of Education *
Father/Guardian - Full Name *
Father/Guardian - Highest Level of Education *
Which of the following best describes your living situation?
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Have you ever been mandated to appear in Juvenile Court? (Your answer will not impact acceptance into the program)
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Have you ever been mandated to appear in Criminal Court? (Your answer will not impact acceptance into the program)
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