Youth Leadership Institute 2025-2026 Intake Form

Youth Leadership Institute 2025-2026 Intake Form

Alpha Kappa Alpha Sorority, Inc. ® Chi Chi Omega Chapter
- Name*
  
  First NameLast Name
- Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Age (program is for students ages 11-13) *
- Grade *
- Gender*
- School Name (no acronyms please)*
- Student, what are you hoping to gain from this leadership program?*
- Youth SYouth MYouth LYouth XLAdult SAdult MAdult LAdult XL
- Please upload a picture of the applicant. No selfies please*
  
  Cancelof
- Name*
  
  First NameLast Name
- Phone Number*
  Please enter a valid phone number.Format: (000) 000-0000.
- Email*
  example@example.com
- Relationship to Youth*
- List any food allergies that your student may have*
  (i.e., dairy, nut (include specifics), etc. If none, enter NONE
- Parent/Guardian, What are you hoping your child will learn in this program?*
- What are your student's strengths?*
  List no more than three.
- What are your student's opportunities for growth or improvement?*
  List no more than three.
- Youth Email*
  *YLI participants must have an accessible method of communication. If your child does not have an email address, please take a moment to create one for them. Google allows parents to create a kid-safe email account under the parent's Gmail account. Please do not use school email accounts.
- Youth Cell Phone Number*
  *Please DO NOT enter the parent/guardian's number. Enter 0's if your youth does not have a cell phone.Format: (000) 000-0000.
- YesNo
- Enter the START and END dates of your youth's spring break.*
- ArtDanceGardening/NatureSocial MediaVideo GamesCodingEntrepreneurshipMusicSocial JusticeVideo/FilmmakingCommunity ServiceFinancial LiteracyPublic SpeakingSportsWritingPhotographyOther
- Parents/Guardians,
  
  Please note the following expectations/information:
  1. This program is a coed leadership institute. It is for girls and boys.
  2. For young ladies- Because this program overlaps with our PEARLS program, YLI participants are unable to participate in both programs.
  3. YLI participants must have an accessible method of communication. If your child does not have an email address, please create one for them. Google allows parents to create a kid-safe email account under the parent's Gmail account.
  4. All monthly YLI sessions are mandatory.
- YES
- YES
- YES
- YES
- YES
- YES
- Parents/Guardians, Please acknowledge that you have read and understand the expectations above and are ready to submit your application.
- Should be Empty: