Youth Leadership Winter Haven

Youth Leadership Winter Haven Class 2 (2023-2024) Application

A Winter Haven Chamber Foundation Program
Thank you for your interest in Youth Leadership Winter Haven!

All applications are due on Wednesday, September 6th at 5p.m.

There is a "Save and Continue" button at the bottom of the application, so you do not have to complete it in one sitting. Jotform will email you a link to pick up right where you left off. We would recommend saving your work throughout.

Please note that you will be required to upload a copy of your Application Agreement. This is to be signed by the student, parent or guardian AND designated school personnel, so do not wait until the last minute!

If you have any questions please contact the Winter Haven Chamber at youthleadership@winterhavenchamber.com or 863.293.2138.
Student Information
Student Name*

First NameLast Name
Home Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Student Email Address*

Confirmation Emailexample@example.com
Student Birthdate

MonthDayYear
Date
Shirt Size*
Parent or GuardianSiblingSelf DrivePublic TransportationI may have obstacles with reliable transportation on class days. (please explain in "other")Other
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email Address*

Confirmation Emailexample@example.com
Educational Information
Current School Name*
Current School Grade*
Are you in a Career Academy or Advanced Curriculum Program? If so, which program?*
What are your post graduation plans? (50 words or less)*

0/50
Work or Volunteer Experience

Prior work experience is not required for acceptance to this program.
YesNo
- Company Name
- Job Title
- Dates Employed
- Past Employer
- Job Title
- Dates Employed
- Organization
- City
- Volunteer Role
- Number of Service Hours
- Additional Organization
- City
- Volunteer Role
- Number of Service Hours
- If you have additional volunteer experiences you would like to share, please upload your document here.
  
  Cancelof
- Career Interests
- AgricultureBusiness/EntrepreneurConstructionEducationEngineeringFinanceFine ArtsHospitalityLaw/JusticeLocal GovernmentManufacturingMedicalNonprofitsTechnologyOther
- Short Responses
  
  These short responses will help us get to know you a little better!
- What challenges facing your school or community are you most passionate about and why?*
  
  0/500
- The Winter Haven area is the second fastest growing area in the country! What opportunities does Winter Haven have as it continues to grow?*
  
  0/500
- Why are you applying to Youth Leadership Winter Haven?*
  
  0/500
- Application Agreement
- Please upload the Youth Leadership Winter Haven Application Agreement.*
  
  Cancelof
- Should be Empty:

Youth Leadership Winter Haven Class 2 (2023-2024) Application

Student Information

Educational Information

Work or Volunteer Experience

Career Interests

Short Responses

Application Agreement