Youth Leadership Institute 2023-2024 Intake Form

Youth Leadership Institute 2023-2024 Intake Form

Alpha Kappa Alpha Sorority, Inc. ® Chi Chi Omega and Epsilon Rho Chapters & Rose of Impetus; FIRST LEADERSHIP SESSION IS SATURDAY, SEPTEMBER 9th FROM 11AM-2PM.

Youth Information
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Age *
Gender*
School Name (no acronyms please)*
Student, what are you hoping to gain from this leadership program?*
List any food allergies that your student may have*
(i.e., dairy, nut (include specifics), etc. If none, enter NONE
Grade (2023-2024 School Year)*
Polo shirt size*

Youth SYouth MYouth LYouth XLAdult SAdult MAdult LAdult XL
Please upload a picture of the applicant.*

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Parent/Guardian Information
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Relationship to Youth*
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 Technology
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.
Does your youth have access to their own laptop and/or tablet that they can bring to each meeting?*

YesNo
Enter the START and END dates of your youth's spring break.*

Expectations
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. There is a minimal fee to participate. This fee will include: Polo, venue, materials, & snacks. Information will be shared at the kickoff.
4. 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.
5. All monthly YLI sessions are mandatory.
I acknowledge that my child must adhere to all behavioral expectations to remain in the program.*

YES
My child will remain engaged with the program and participate to the best of his/her abilities.*

YES
I understand that there are expectations for YLI participants to be respectful of peers and adults who are participating in this program.*

YES
Parents/Guardians, Please acknowledge that you have read the expectations above.

Clear
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