2021 LI YDP Summer Program Enrollment

This form is no longer active. The updated enrollment form can be found here.

2021 Summer Program Enrollment
Students enrolling in our programs must be at least 13 years old by the time the program begins. Students must be entering 9th through 12th grade in the fall of 2021 to be eligible for the summer programs. Seniors graduating in 2021 will automatically be enrolled in our advanced track programs.
Student Information
Student First Name *
Student Last Name *
Student Email *
example@example.com
Student Phone Number *
Student Preferred Gender Pronoun (optional)
Student Gender *
Student Birthday *
Please indicate your current living status: *

Currently living in the U.S./home address is within the U.S. Currently living abroad/home address is outside of the U.S.
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Background Check/Non-Disclosure Agreement *
By entering your initials above you are agreeing that you and your parents must are willing to undergo a background check and sign and uphold a non-disclosure agreement as needed when working as an intern for a partner law firm, as an intern with our business partners, and/or as an intern to work with patients in the medical program. By entering your initials above, you are agreeing to both of these conditions of enrollment.
If you encounter any issues filling out the 2021 Program Enrollment Form, please call (202) 738-1115 for assistance.

Parent/Guardian Information
Parent/Guardian First Name *
Parent/Guardian Last Name *
Parent/Guardian Email *
example@example.com
Parent/Guardian Phone Number *
Is Parent/Guardian address the same as the student's address? *

Yes No
Parent/Guardian Address *

Street Address

Street Address Line 2

City State

Zip Code
If you encounter any issues filling out the 2021 Program Enrollment Form, please call (202) 738-1115 for assistance.

Student's School Information
Are you currently attending high school or being home schooled? *

High School Home School
Expected Graduation Year *
High School Name *
Home Schooling Association (If Applicable)

Payer Information
Is the Payer information the same as the Parent/Guardian information provided?

Yes No
Payer First Name *
Payer Last Name *
Payer Email *
example@example.com
Payer Phone Number *
Please continue on to the next page to select your payment plan and form of payment.

If you encounter any issues filling out the 2021 Program Enrollment Form, please call (202) 738-1115 for assistance.

2021 Summer Program Enrollment