YLA Application

SELECTION CRITERIA

Youth Leadership Academy (YLA) of Madison County is committed to providing leadership development and training to a group of motivated students who represent a diversity of racial, ethnic and socio-economic groups in Madison County.

Interested nominees should:

Demonstrate their potential for developing leadership skills
Participants must live in or work in Madison County.
Applications will be reviewed by a selection committee and notifications will be made to participants and families.
Participants should exhibit interest in community service
Commit to FULL PARTICIPATION AND ATTENDANCE in all YLA programs. Participants who fail to attend more than two (2) sessions are at risk for not receiving their certificate of completion.
Maintain satisfactory academic, attendance and citizenship records
Tuition will be due upon acceptance in the program
Each applicant must request an adult to complete the Student Recommendation Form, which is linked at the bottom of the application.

ATTENDANCE

Due to a limited number of positions in the class, a commitment to the program and full attendance at each activity is expected. If you cannot make a full commitment to the program please do not apply.

Please complete the following application.

Personal Information

Full Given Name

Preferred Name

Cell Number

Personal Email Address

Home Address

City

State

Zip Code

What Is Your Gender

Male

Female

Birth Date

Age

Race

School Presenty Attending

Grade

T-Shirt Size *

How did you hear about YLA *

Parent Information

Parent or Guardian Names

Parent Street Address

Parent Phone Number

Parent Email Address

Parent or Guardian's Workplace

Alternate Emergency Name

Alternate Emergency Phone#

Organizations And Activities

Please list any school, volunteer, religious, social, athletic or other activities in which you have participated. Explain what role you play in these organizations.

Activties

Resonsibilities

Work Experience

List any job experience, full-time or part-time, and briefly explain

Do you currently have a job *

Yes

If Yes, where do you work

Will your employer make reasonable accommodations

so you can participate *

Yes

If no, please explain

Personal Profile

Describe three qualities

which best illustrate your leadership *

What two leadership traits

do you hope to improve most through YLA *

What is the biggest issue

high school students

are wrestling with today *

Why do you want to

participate in YLA *

What do you hope to gain from this experience *

If you could improve one thing in our community what would it be, and why *

I have read and agree to the Selection Criteria and Applicant Commitment information *

Yes

An error occurred. Please be sure all fields are completed

Each applicant must request an adult to complete the Student Recommendation Form. This adult should be someone who knows the applicant personally and can attest to the applicant's character and leadership potential. Past applicants have provided recommendation forms from teachers, employers, church leaders and extracurricular group leaders/coaches. Recommendation forms should not be completed by parents/guardians, family members or peers. Please do not hesitate to reach out to us with any questions.

Link to Send Reference Form