LEAD Four Twelve Application 2026/2027

LEAD Four:Twelve 2026 Cohort Application
Before you apply, please take a moment to review the requirements and expectations for LEAD Four:Twelve here:

1. I understand by completing this application that I am committing to being present and active in all of the LEAD Four: Twelve retreats.
2. It is expected that all LEAD Four: Twelve graduates will staff one week as either Kitchen Staff or J Staff in the summer of 2027.
3. I understand that my acceptance into LEAD Four:Twelve is contingent on my full commitment to attending each of the LEAD Four:Twelve retreats and activities. As this takes a great commitment of time I am also affirming that I have the full support of my parents or guardians and/or my church family to help make this possible.

At the final LEAD Four:Twelve retreat, graduates will receive a certificate of completion.

IMPORTANT: It is critical that you take time to carefully and thoughtfully answer all of the questions on this application. Your application is the main source for us getting to know you and we place a great deal of emphasis on how you respond to these questions. Outside of your youth leader and the references you provide, this application is what we use to decide whether or not to accept you into the LEAD Four:Twelve experience.

The last section of this application requires a parent or guardian to provide consent and confirmation of your application. Be sure to have a parent or guardian nearby to complete this final portion of your application.
LEAD Four:Twelve Tuition/Retreat Dates

Tuition:

$695.00 is the tuition for the one-year experience. This amount may be paid in four installments over the course of the LEAD expereince. The initial deposit of $200 is due by Dec. 15, 2025 and is non-refundable.

Retreat Dates:

The LEAD experience requires attendance at all 4 retreats.

Retreat #1: March 13-15, 2026 in Goshen, VA (same weekend and location as the JOURNEY retreat).

Retreat #2: July 7-9, 2026 in Romney, WV.

Retreat #3: November 6-7, 2026 (Saturday-Sunday) overnight retreat at Lake Anna, just north of Richmond.

Retreat#4: March 12-14, 2027 in Goshen, VA (same weekend and location as the JOURNEY retreat).
I am aware of the retreat dates and have discussed them with my family to ensure that I will be able to participate in all 4 retreats.*

YesNo
Your Name*

First NameLast Name
Home Church:*
Your Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your Email*
example@example.com
Cell Phone Number*
Please enter a valid phone number.
Your Birthday*

MonthDayYear
Date

How would you respond to the following statements:*

	Never	Rarely	I Don't Know	Sometimes	Definitely
I follow through on commitments.
I understand my gifts and talents.
I have mentors in my life.
I believe in serving others
I believe in Jesus Christ as the Son of God
I regularly read the Bible.
I regularly pray.
I regularly worship.
I attend youth group regularly.
I feel comfortable talking to others about my faith.
I enjoy learning.
I enjoy learning from those older than me.
I feel comfortable asking questions from those older than me.

How do you think others perceive you?*

	Definitely	Sometimes	I Don't Know	Rarely	Never
Others see me as responsible.
Others see me as a leader.
Others believe I take my relationship with Jesus seriously.
Others see I am committed to serving others.
Others see I am committed to my church.

Why do you want to participate in LEAD Four:Twelve?*

0/250
What is an issue in the world that you care deeply about?*

0/250
Share a little about your faith journey and try to be as authentic as possible.*

0/500
How do you hope to grow as a follower of Jesus over the LEAD Four:Twelve experience?*
How would you define service? *

0/250
How would you define leadership?*

0/250
What leadership qualities do you believe you already have?*

0/250
How do you hope to grow as a leader during the LEAD Four:Twelve experience?*
Reference #1 Contact Information

We will be emailing two people a quick survey about your leadership abilities. One needs to be a teacher/counselor from school and the other can be anyone of your choice (non-family member). We will also be contacting your youth director for a recommendation. Please provide us with the following information for the first reference:
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
How do you know this person?*
Reference #2 Contact Information

We will be emailing two people a quick survey about your leadership abilities. One needs to be a teacher/counselor from school and the other can be anyone of your choice (non-family member). We will also be contacting your youth director for a recommendation. Please provide us with the following information for the first reference:
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
How do you know this person?*
How long has this person known you?*
How long has this person known you?*
To Be Completed by Parents or Guardians of Applicant
Parent or Guardian Approval: By signing your name, you understand the financial commitment required by you as the parent/guardian of this applicant ($695.00 for the one-year experience due over the course of 4 payments. If accepted, the initial deposit of $200 is due by Dec. 15th, and is non-refundable).

Additionally, in the event that your son or daughter withdraws from the LEAD Four:Twelve experience for any reason after the initial deposit has been paid, you are still responsible for paying the full amount ($695.00) to the Jeremiah Project, as there are no refunds.

You are also aware of the time commitment and travel that must be made to ensure your student can participate in the entirety of the LEAD Four:Twelve experience.

Lastly, by signing your name you are aware of the 4 retreat dates that your son/daughter MUST attend in their entirety in order to participate in the LEAD experience (these can be found at the beginning of the application or on the LEAD website: www.Lead412.org).
Parent Contact Information
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Parent's electronic signature*

Clear
Should be Empty:

LEAD Four:Twelve 2026 Cohort Application

Reference #1 Contact Information

Reference #2 Contact Information

To Be Completed by Parents or Guardians of Applicant

Parent Contact Information