Youth Program Application

Youth Summer Institute Application

Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Date of Birth*
MM slash DD slash YYYY
I am a
- Rising Junior
- Rising Senior
- Graduating Senior
Email
Home Phone
Cell Phone
Parent/Guardian*
Parent/Guardian Daytime Phone (in case of emergency)
Parent/guardian Email
High School
GPA*
Days absent during the last three school semesters*
Shirt size*
- XS
- S
- M
- L
- XL
- XXL
- XXXL
Dietary Restrictions
Please list up to 4 areas you would be interested in shadowing (examples: health care, engineering, accountant, PR Marketing, trades etc.)
How did you find out about the Leadership Geauga County Youth Leadership Institute?*
- At school
- On the web
- From a friend
References
School Reference Name:*
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email
Phone
Community Reference name #1:*
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email
Phone
Phone
If you are currently working, list the name of the name of your employer (business) and how many hours you work each week.
Extracurricular Activities at School
Please list, in order of importance to you, up to four extracurricular activities in which you are involved at school.
Please include: Activity/Organization - Your Leadership Position - Hours/Week - Years Involved
Awards/Honors
List major awards, honors or recognition you have received for academic, school, or community-related activities including the dates.
Essay Question
Please describe why you are applying to the Leadership Geauga Youth Leadership Institute and what you hope to gain from the experience.*
Scholarship Application - Leadership Geauga County has a limited amount of financial aid available to individuals who could not participate in the program without subsidy. These funds are raised through corporate gifts, grants, and the annual fund raising activities.
Name
First Last
school
Date
MM slash DD slash YYYY
Reason for the request (a reason is required)
Amount requested
How will the remainder of the tuition be paid? (All participants must pay at least $100)
How will the remainder of the tuition be paid? (All participants must pay at least $100)

Youth Program Application

Youth Summer Institute Application

References

Extracurricular Activities at School

Awards/Honors

Essay Question

Scholarship Application - Leadership Geauga County has a limited amount of financial aid available to individuals who could not participate in the program without subsidy. These funds are raised through corporate gifts, grants, and the annual fund raising activities.