Parent and Family Application

Parent and Family Application

Parent/Guardian Must Complete This Form in its Entirety Prior to The Interview Day. Deadline is September 1.
The First Ladies Youth Leadership Foundation, Inc. (First Ladies) is excited to have your young lady(ies) participate in our afterschool mentor leadership program. This program specifically addresses the issues that impact girls in grades 6-12. Annually, we will target 3-12 areas: (1) Purpose/Identity Development/Mental Health, (2) Mentorship, (3) Leadership, (4) High School Readiness, (5) College Readiness, (6) Career Readiness, (7) Building Healthy Families, (8) Building Sisterhood, (9) Etiquette, (10) Financial Literacy, (11) Community Service and (12) Entrepreneurship.

This program is designed to provide positive role models and support for young girls, and First Ladies believes that we will offer a valuable experience for your young lady(ies). Our mentors are thoroughly vetted with background checks via the State of Georgia or the local county and are classified as Mandated Reporters.

As the parent or guardian, you, your child/youth, and your family are important to our First Ladies Founder and mentors. To prepare for success, please make sure to complete the following by no later than September 1.

Application Fee

The Application Fee should be submitted via Cash App at $FirstLadiesFdn or using the PayPal link below. The Application Fee goes towards the Annual Dues which totals $160. The Application Fee is deducted from the annual dues.

Sponsorships are available. No child will be turned away because of a financial challenge communicated within the application process. If there is a financial issue, email imentor@firstladiesyouthleadershipfdn.org and ask for sponsorship details.

First Ladies Annual Dues go towards the Annual Launch, Induction Ceremony, Student Birthday Celebrations, or the End of Year Scholarship Awards Banquet. Additional Details Made Available During the Program.

Student Application/Essay/Voice Recording/Photo

Grades 6-12 students are responsible for completing the student application by or on the September 1 deadline. The application process is a part of our First Ladies college readiness pillar and models a college common application. To expose our grades 6-11 students to what to expect for college enrollment the application process is meant to not only prepare the young lady for the First Ladies journey but to also be a learning process for college admittance.

Grades/Discipline Report

The parent or child can submit these reports. Grade 6 students with no discipline report can upload a blank page with the words "No Discipline Report" on the form. Reports must be submitted by September 1. The links have been made available via this form.

Recommendation Forms

Teacher Recommendations forms (1) Community Leader and All Core Teachers - Math, Science, English - must be submitted by all applicants.
To access the Teacher Recommendation Form, copy and paste the link below. Recommendations from the present or previous year's teachers are acceptable.

Click the following link: https://form.jotform.com/222084027689158

To access the Community Leader Recommendation Form, copy and paste the link below. The Form can be completed by a mentor, pastor, coach, employer, etc.

Click the following link: https://form.jotform.com/222083980303148
Optional: To Attach Link to Child's Video Essay, Upload Video (3 Minutes or Less) Here

Cancelof
Parental Consent

Instructions: Please type in your initals or fill in the blanks.
I, the undersigned   First NameLast Name   , am the parent or legal guardian of the child/youth named   First NameLast Name   , my child was born on   Date of Birth  and resides in   Street AddressAddress Line 2CityStateZip    . I am available for phone calls at   Area CodePhone Number and via email at   Email

Type a label   I understand that First Ladies is a 21-week afterschool leadership development program that is a faith-based and community-based partner to grades 6-12 schools and is not a school-based program.

Type a label   I understand that my child/youth will meet with one of the First Ladies middle or high school chapters once a week (typically on Thursdays) after school for one hour and fifteen minutes.

Type a label   I also understand that my child/youth will be required to participate in 1-2 activities per month on the weekend, such as attending group meetings, activities, or community service.

Type a label I give my permission for my child/youth to participate in all aspects of the program.

Type a label   I understand that I will be responsible for any travel to and from any program activities.

Type a label   I will support the mentor match by communicating with my child/youth's mentor and with the program regularly.

Type a label   I also give my permission for my child/youth to share personal information with her mentor, as appropriate, and understand that the information will be confidential unless at any time the mentor is concerned about any safety issues.

Type a label   I understand that my child/youth's participation in First Ladies is voluntary and that she can withdraw from the program at the end of the school year. If there is a reason or need for withdrawal before the end of the school year, I agree to contact First Ladies and complete an exit interview before withdrawal.

Type a label   I agree to the use of my child/youth's photo on the First Ladies website, newsletter, social media outlets, and other forms of program material.

My child currently has/had the following conditions/diseases:   ChickenpoxMeaslesMumpsAsthmaSinusitisBronchitisDiabetesHeart TroubleOther Conditions/Diseases   , and has these allergies:   Insect StingPollenNutPoison Ivy, OakSoyWheat,   Other Allergies.

Type a label   I agree to pay for any and all medical expenses incurred and give permission to the doctor or health care professional to provide medical care if necessary.
First Ladies teaches its participants the importance of dreams and goals. Please briefly share you/your family's goals for your child/youth in general and why you want her to join First Ladies?
Attach Your Child/Youth's Discipline Report. Upload Document Here.

This can be obtained from the school's records clerk or counselor.
Cancelof
One of the First Ladies pillars is high school, college and career readiness. After completing three successful years in First Ladies, high school seniors are eligible for the Wanda Lynette Hill Scholarship. Please share if you want your child/youth to go to college? If you have begun planning for her college entrance? If so, please briefly share how you have begun preparation and how you would like First Ladies to help with your child/youth's education. (i.e.. haven't started yet, 529 savings plan, scholarship applications, etc.)
Attach Your Child/Youth's Most Recent Grades Report. Upload Document Here.

This can be obtained from your child/youth's student portal (i.e. Infinite Campus) or the school's records clerk or counselor.
Cancelof
One of the First Ladies pillars is financial literacy and entrepreneurship. First Ladies is in partnership with Bank of America to provide your child/youth with financial tools. Will your child/youth have access to a computer or laptop to complete the 4+ week activity?*
Emergency Contact Person

(different than the person who has primary guardianship)
Relationship to the child blanks*. In the case of an emergency, do you permit this person to pick up your child from a First Ladies activity? (yes or no) blank*
Emergency Contact Person's Name

First NameLast Name
Emergency Contact Person's Phone Number*
Please enter a valid phone number.
Emergency Contact Person's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
NOTICE OF NONDISCRIMINATORY POLICY AS TO OUR PARTICIPANTS

The First Ladies Youth Leadership Foundation, Inc. admits female youth of any race, color, national and ethnic group to all the rights privileges, programs, and activities generally accorded or made available to its female youth leaders in First Ladies. It does not discriminate based on race, color, national and ethnic origin in the administration of its educational policies, admissions, general policies, sponsorship, and other programs.

I hereby voluntarily release, forever discharge the community, the corporation, the school, its officers, directors, employees, volunteers, and agents from any and all claims, demands, or causes of action, which are connected with my child/youth's participation in First Ladies or the use of the equipment and facilities.

The information I've given in this form is complete and accurate. If I have any questions, I can attend the August parent informational or email imentor@firstladiesyouthleadershipfdn.org for more information.

By signing this form, I confirm that I have fully informed myself of the contents of this Parental Consent and Release Form by reading it before I signed it. I warrant that I possess all the rights, powers, and privileges of a parent or legal guardian necessary to execute this document with binding legal effect.
Parent/Guardian Signature*

Clear
Date

MonthDayYear
Date
Date of Birth*
To Verify Entries Are Made By An Adult, Please Input Your D.O.B. (Only the Month and Year)
My Products
prevnext( X )
Registration/Application FeeSchool-Year 2024-25 Payment goes towards the $160 annual dues.
$49.00 Quantity

Total

$0.00

Payment Methods

Debit or Credit Card

Please click one of the PayPal options to complete payment and submit the form.

Should be Empty:

Parent and Family Application

Parental Consent

Emergency Contact Person