Apply for Youth Action's 2023-24 Inspiring Leaders Program

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Youth Action's ILP application is broken into four parts. Parts 1 and 4 can and should be completed by the student applicant. Parts 2 and 4 can be completed with help from a parent or guardian:

Part 1 captures Student Applicant's Personal & Contact Information (5 mins)

Part 2 captures Parent or Guardian Contact Information (2 mins)

Part 3 captures Student & Family Demographic Information (3 mins)

Part 4 is the Short Essay section (10-15 minutes)

If you have any additional questions, please contact us at inspire@youthactionteam.org.

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Full Name* This field is required.

First Name

Last Name

Suffix

3

Preferred Name/Nickname

4

Birth Date* This field is required.

5

Gender* This field is required.

Female

Male

Prefer not to say

6

Current Address* This field is required.

Street Address

Street Address Line 2

City

State

Zip Code

Country

7

Mobile Number* This field is required.

Area Code

Phone Number

8

Primary Email* This field is required.

9

Name of Current School* This field is required.

10

School Type* This field is required.

11

Grade Level in Fall 2023* This field is required.

12

Parent/Guardian's Full Name* This field is required.

First Name

Last Name

Suffix

13

Relationship to Student* This field is required.

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Parent/Guardian's Mobile Phone Number* This field is required.

Area Code

Phone Number

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Parent/Guardian's Primary Email* This field is required.

example@example.com

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Ethnicity* This field is required.

Hispanic or Latino

Not Hispanic or Latino

Prefer not to answer

17

Race* This field is required.Select all that apply.

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White or Caucasian

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How many people live in your house including you?* This field is required.

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What is your family's estimated household income?* This field is required.

Less than $25,000

$25,000 to $34,999

$35,000 to $49,999

$50,000 to $74,999

$75,000 to $99,999

$100,000 to $149,999

$150,000 to $199,999

$200,000 or more

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Writing Prompts: In addition to prompt #1, select ONE ADDITIONAL prompt that you would like to respond to.* This field is required.

Explain why YOU want to participate in the Inspiring Leaders Program. (Required)

If you had $1,000,000 to address any ONE issue or challenge in Philadelphia (or surrounding areas), what would the issue be, and how would you use the money to bring change?

Who or what inspires you and why?

Describe an experience or situation where you had to step up as a leader. What lessons did you learn from this experience?

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Explain why YOU want to participate in the Inspiring Leaders Program.* This field is required.

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Writing Prompt #2* This field is required.

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Is there any other information that you would like to share with us?

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Signatures & Application Submission* This field is required.I certify that the information I have given on this application is complete and correct.

Student E-Signature

Parent/Guardian E-Signature

Submission Date (mm/dd/yyyy)