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Leadership Greater Jackson (LGJ)
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Apply to Youth Leadership (YLJ)
Home
Apply to Youth Leadership (YLJ)
YL Application
Step 1 of 8 - Personal Info
12%
Given Name
*
First
Middle
Last
Name you prefer to be called
Home Phone
Cell Phone
Email
Race
*
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Other
Gender
*
Male
Female
Date of Birth
*
Date Format: MM slash DD slash YYYY
Home Address
*
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
School Name
*
Other Schools Attended
School Name
Year(s) Attended
Special Awards, Honors or Recognitions
List up to three special awards, honors, or recognition for academic, school or community-related activities you have received from the 7th to 10th grades.
What is your main area of interest in studies?
Organizations and Activities
Please List in order of importance to you up to five school, volunteer, religious, social, athletic or other activities or organizations in which you have participated during the past four years.
Organization/Activity
Grade in School
Leadership Responsibility/Involvement
Work Experience
List any part-time job experience, paid or volunteer, and briefly tell what it involved.
Employer
From
To
Do you currently have a part-time job?
YES
NO
How many hours per week?
Would your job interfere with your attendance at You th Leadership Jackson?
YES
NO
Using a few phrases or adjectives, describe yourself.
*
What three things concern you most about your life in Greater Jackson area?
*
What else would you like to tell us about yourself?
*
If you could change anything in your community, what would it be and how?
*
Please respond in 250 words or less.
References
Please give one reference form to your high school principal / headmaster or counselor. Give the second one to any adult who knows you well, other than a parent or relative, for example, a teacher, scout leader, church youth leader, etc. If this is your first year at your current school, give the second reference to a teacher, principal / headmaster or counselor at the school you attended last year.
Position/Title
Address
Phone Number
Attendance
*
100% attendance is expected of each participant and school attendance credit will be granted for each school-day session attended. To make sure you do not have unavoidable conflicts, please compare your schedule with the program calendar dates on the enclosed information sheet before completing your application.
If selected, do you make a commitment to attend each one of the six program sessions from the Opening Retreat through the Closing Retreat?
YES
NO
Comments
This field is for validation purposes and should be left unchanged.
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