YLI Program 2023 Application

Youth Leadership Institute Program Application 2023

APIDC’s Youth Leadership Institute trains young adults to become advocates for APIs with disabilities. We seek college students from all backgrounds and ethnicities who have a passion for empowering APIs with disabilities.
Personal Information
Name*

First NameLast Name
Preferred Name
Preferred Pronouns*
Gender*
Are you 18 years or older?*

YesNo
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone*
ex: (123) 456-7890
Education Background
Do You have a high school diploma or GED certificate?*

YesNo
Are you currently attending college?*

YesNo
College (if answered "No" enter N/A)*
Program/Major (if answered "No" enter N/A)*
Program Information
How did you first learn about the program?*
Do you have/experience with a disability or disabilities?*

YesNo
Please describe disability/disabilities*
Are you able to attend all sessions of the YLI program? (April 16, 23, 30, and May 7 with Graduation on May 14)*

YesNo
If you need any accommodations please describe below (enter N/A if none)*
Skills/Expertise
Please rate your skills/expertise according to the following scale:

None: Not knowledgeable; no personal (first hand) experience

Fair: knowledgeable; no/little personal (first hand) experience

Good: personal (first hand) experience; competent

Excellent: personal (first hand) experience; expert

Skill/Expertise Rating*

	None	Fair	Good	Excellent
Advocacy
Oral Communication Skills
Written Communication Skills
Conflict Resolution
Legislation
Marketing
Mentoring
Public Relations
Public Speaking
Problem-Solving
Working in Teams

Short Essay
What do you think makes a good leader? Describe with one or two examples how you are a leader in your school, community, or home. What are you looking to gain by participating in APIDC's Youth Leadership Institute in terms of personal growth and future opportunities.*
Agreement
I agree that all of the information in this application is true. I agree that if chosen to participate, I will participate in all program activities, including implementing a community-based project within 12 months upon completion of the program. I understand that APIDC reserves the right to dismiss at any time any participant whose involvement, in the judgment of APIDC, would not be in the best interests of the Youth Leadership Institute.
Signature*

Clear
Date*

MonthDayYear
Should be Empty:

Youth Leadership Institute Program Application 2023