2021 LI YDP Summer Program Enrollment

2021 Summer Program Enrollment
Our 2021 Summer Youth Development Programs are now complete. If you would like to enroll in our 2022 Summer Youth Development Programs please fill out the form below

Click Here To Access The 2022 Youth Development Programs Enrollment Form

Student Information
Student First Name*
Student Last Name*
Student Email*
example@example.com
Student Phone Number*

Area CodePhone 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

CityState / Province

Postal / Zip CodeCountry
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*

Area CodePhone Number
Is Parent/Guardian address the same as the student's address?*

YesNo
Parent/Guardian Address*

Street Address

Street Address Line 2

CityState

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 SchoolHome 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?

YesNo
Payer First Name*
Payer Last Name*
Payer Email*
example@example.com
Payer Phone Number*

Area CodePhone 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