MetaDux Youth Community Leadership Program Application
The MetaDux Youth Community Leadership Program has a mission to provide a sustainable leadership program that empowers high school students to realize their own capabilities, develop their potential, and impact our community. Applicants will be involved with sessions that include topics that are timely and relevant to leadership—skill building, career paths, and what leadership looks like in different occupations. Students can apply in the spring of their sophomore year to participate in their junior year will require your attendance one day a month (during school time) for 8 months. Eligibility: Current high school sophomores who attend public and private schools in the Johnson County area may apply. If accepted, applicants will participate in the program during their Junior Year. Cost: The program is FREE to all accepted participants. Selection Process: Using the objectives of the MetaDux Youth Community Leadership Program, the Selection Committee will review all applications. Applications will remain confidential. APPLICATION DEADLINE: May 17, 2023
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Applicant's Information
Please use this section to complete information about yourself
Applicant's Name
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First Name
Last Name
Applicant's Preferred pronouns
Applicant's Date of Birth
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-
Month
-
Day
Year
Applicant's email
*
example@example.com
Applicant's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Applicant's High School currently attending
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West High School
Liberty High School
City High School
Tate High School
Applicant's Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Parent/ Guardian Information
Please use this section to complete information about your parent/guardian
Parent /Guardian Name
*
First Name
Last Name
Parent/Guardian Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Email
*
example@example.com
Additional Parent/Guardian information
Please use fields below to enter additional parent/guardian information
Parent /Guardian Name
First Name
Last Name
Parent/Guardian Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Email
example@example.com
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Application Questions
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Describe yourself, detailing your strengths/assets.
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List up to 3 accomplishments that make you proud.
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List any extra curricular activities that you are currently or have previously been involved with. (ex. sports, clubs or organizationals)
*
Why would this program be a benefit to you?
*
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References
Use this section to list up to 3 references that will highlight your willingness and ability to engage positively in the Youth Community Leadership Program.
Reference
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Reference Name
*
First Name
Last Name
Reference Email
*
example@example.com
References relationship to you
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Coach
Teacher
Principal/School Administrator
Other
Additional Reference
Reference Name
First Name
Last Name
Reference Email
example@example.com
References relationship to you
Coach
Teacher
Principal/School Administrator
Other
Additional Reference
Reference Name
First Name
Last Name
Reference Email
example@example.com
References relationship to you
Coach
Teacher
Principal/School Administrator
Other
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