Youth Ambassador Program
Admission Application
Youth Name
First Name
Last Name
Email
example@example.com
Birthday
-
Month
-
Day
Year
Date
Parent/Guardian Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Grade as of (4/1/21)
6
7
8
9
10
11
What is one thing in your community that you would like to change and why?
What does leadership mean to you?
How good are you at time management?
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
How well do you work with others?
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Are you committed to meeting every Tuesday evening for a 1 hour zoom?
Yes
No
Do you have access to a laptop?
Yes
No
Are you able to meet in person every Saturday 10am-2pm?
Yes
No
Signature
Submit
Should be Empty: