30th Annual LYLC Application: 2023

30th Annual LYLC Application: 2023

July 11, 2023 - July 19, 2023
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The Latino Youth Leadership Conference brings together Latinx high school students in Nevada for six days of leadership training and development.

The goals of the Latino Youth Leadership Conference are to:

1. Empower youth through leadership, development, and community service.
2. Encourage youth to pursue and complete higher education.
3. Emphasize cultural, community, and family values.

The conference begins on July 11, 2023 and ends on July 16, 2023 at the University of Nevada, Las Vegas. Participation in the LYLC is completely FREE. Accommodations and conference materials are provided at no cost to participants or their families. The LYLC is open to incoming high school juniors through exiting high school seniors, sixteen to eighteen years of age. In order to attend the LYLC, all participants must be fully vaccinated against Covid-19 OR present a negative Covid-19 test taken a maximum of 3 days before the conference.

Application Deadline: April 28, 2023

Contact Us with Any Recruitment and Application Questions Here:
lvlylc.recruitment@gmail.com
Applicant Information
Email: Please do NOT use a CCSD or school email*
Name*

First NameLast Name
Preferred Name/Nickname *
(Ex: Christopher --> Chris)
Preferred Pronouns*
Ex. He/She/They El/Ella/Elle
Birth Date*

MonthDayYear
Gender*
Sex*

FemaleMale
Address*

Street Address

Street Address Line 2

CityState

Postal / Zip Code
Cell Phone*
Please enter a valid phone number.
Home Phone
Please enter a valid phone number.
May we text the provided cell phone number?*

YesNo
How did you obtain this application?*

FriendTeacherCounselorParentSocial MediaFlyerLYLC Recruiter/StaffOther
Please provide Recruiter/Staff name if selected above
T-Shirt Size*
Unisex, Men Sizes
The LYLC starts July 11, 2023, and ends July 16, 2023. Will you be able to attend the whole conference?*

YesNo
Have you previously attended the LYLC? If yes, what year did you attend the conference?*
Do you know anyone who will be attending the LYLC in 2023? If yes, please list name and relation:*
Ex: Yes, my best friend Regina Phalange
Medical Information
Will you be taking any medications during the LYLC? If yes, does it require any accommodations? *
(i.e. refrigeration, specific schedule)
Do you have allergies or dietary concerns? *We will try to accommodate to our best ability**

VegetarianVeganPescatarianLactose IntolerantNut AllergyGluten-FreeOtherNone
Do you have a disability requiring special accommodation?*
If yes, please specify
Education Information
What High School do you attend?*
Current Grade Level*

SeniorJuniorSophomoreFreshman
Do you plan on continuing your education after high school? If yes, what institution?*

University of Nevada, Las VegasUniversity of Nevada, RenoNevada State CollegeCollege of Southern NevadaTrade/Vocational SchoolOther
Have you ever been convicted of a felony?*
If yes, please explain.
Conference Questions

Short-answer questions
List THREE of your strengths*
What fictional character describes who you are and why?*
We want to get a sense of who YOU are. There is no right or wrong answer. The character can be from anywhere; a cartoon, TV show, movie, or book! | Maximum Word Count: 150
Leadership, What is it?*
What does leadership look like through your eyes: home, school, workplace, community? What leaders have been in your life? What does it take to be a leader? | Maximum Word Count: 150
Describe an event that impacted your life? How has this affected you?*
How did this event CHANGE you, your surroundings, or others? Was the impact positive or negative? | Maximum Word Count: 250
What are your goals/aspirations? What motivates you to achieve them?*
We want to know what goals you have for yourself: Academic/Educational, professional, short-term goals, and long-term goals. What or who inspires you to reach your goals? | Maximum Word Count: 250
What makes you angry and why?*
What Twitter hashtag gets you going? What social movement do you follow? | Maximum Word Count: 150
Emergency Information

The final section of the application must be completed with the parent/guardian of the applicant
Emergency Contact Name #1*

First NameLast Name
Emergency Contact Phone #1*
Please enter a valid phone number.
Emergency Contact's Relation to the Applicant #1*
Emergency Contact Name #2*

First NameLast Name
Emergency Contact Phone #2*
Please enter a valid phone number.
Emergency Contact's Relation to the Applicant #2*
Release and Disclaimer Forms
Liability Release Form

Latino Youth Leadership Conference - July 11, 2023 - July 16, 2023
I, (Parent/Guardian) __________________________________, being the legal guardian of (Applicant)_________________________________, grant my son/daughter permission to reside, attend, and participate in the 2023 Latino Youth Leadership Conference for its entirety.

1. The Latino Youth Leadership Alumni/Conference/Foundation provides a variety of opportunities, which often require local travel, including college tours, low ropes activities, retreats, academic, career, and cultural enrichment trips or activities. Trips or activities often involve intense movement, are of long duration, and/or are often intellectually challenging and physically rigorous activities. I understand that such risks simply cannot always be eliminated without jeopardizing the essential qualities of the services and activities.

2. I understand that a violation of one of the following behaviors during the program will result in immediate removal at the cost of the parent/guardian: Drug/alcohol/tobacco use and/or possession, physical and/or verbal harassment, vandalism, arson, and sexual misconduct. Additionally, the program staff reserves the right to remove a participant with reasonable cause.

3. I hereby authorize the program staff to act for my child according to their best judgment in an emergency requiring medical attention. I agree to be responsible for any and all medical or other charges incurred due to an emergency situation involving my child.

4. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless the Latino Youth Leadership Alumni/Conference/Foundation, its staff, and its affiliates from any and all claims, demands, or causes of action, which are in any way connected with my participation in this activity or my use of equipment or facilities, including such claims which allege negligent acts or omissions by the program staff. I expressly agree and promise to accept and assume all of the risks related to participating in the 2023 Latino Youth Leadership Conference. My participation in this activity is purely voluntary, and I elect to participate in spite of the risks.

5. Finally, by signing this document, I acknowledge that I may be found by a court of law to have waived my right to maintain a lawsuit against the Latino Youth Leadership Alumni/Conference/Foundation Program, staff, and its affiliates.
Parent/Guardian Name*
Applicant Name*
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
Today's Date
Applicant Signature*

Clear
Date*

MonthDayYear
Today's Date
Photo Media Release
I, (Parent/Guardian) ________________________, being the legal guardian of (Applicant) ___________________________, GRANT the Latino Youth Leadership Alumni/Conference/Foundation and persons acting on their behalf or through them the right to use, reproduce, assign and/or distribute photos, films, video, and sound recordings of above listed minors for use in materials they may create.
Parent/Guardian Name*
Applicant Name*
Signature of Parent/Legal Guardian*

Clear
Date*

MonthDayYear
Today's Date
Covid-19 Consent Form

The Latino Youth Leadership Conference is committed to the health and safety of our student participants, guest speakers, peer staff, adult staff, and our familias. We have taken enhanced health and safety measures for our participants, staff, peer staff, and our families. You must follow all posted Safety Guidelines while
attending the Latino Youth Leadership Conference (LYLC).

Notwithstanding our efforts, an inherent risk of exposure to COVID-19 exists in any public place where people are present; we cannot guarantee you will not be exposed during your visit. COVID-19 is an extremely contagious disease that can lead to severe illness and death. According to the CDC, older adults and guests of
any age who have serious underlying medical conditions are especially vulnerable. Guests should evaluate their risk in determining whether to visit.

-By attending LYLC, you are also agreeing that you are fully vaccinated, you will present a negative Covid-19 test, and you will help keep yourself and others safe while adhering to all local, national, and organizational mandated guidelines which may include wearing masks, or adhering to temperature checks among others.
-By visiting the LYLC, you voluntarily assume all risks related to exposure to COVID-19.
-By attending the LYLC, you are confirming that you are not experiencing any of the following symptoms of COVID-19 identified by the Centers for Disease Control and Prevention at CDC.gov, including:

● Fever or chills
● Cough
● Shortness of breath or difficulty breathing
● Fatigue
● Muscle or body aches
● Headache
● New loss of taste or smell
● Sore throat

● Congestion or runny nose
● Nausea or vomiting
● Diarrhea
● Have been in contact with someone who confirmed or suspected COVID-19 symptoms without completing a 14-day quarantine
● Being under any self-quarantine orders

Participant's Signature*

Clear
Date*

MonthDayYear
Today's Date
Should be Empty:

30th Annual LYLC Application: 2023

Applicant Information

Medical Information

Education Information

Conference Questions

Emergency Information

Release and Disclaimer Forms

Liability Release Form

Photo Media Release

Covid-19 Consent Form