Youth in Aviation Participant Application
Please contact youthinaviationyia@gmail.com or 404-862-4438 if you experience any problems with this application.
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Contact Information
Applicant Full Name
*
First Name
Last Name
Age
*
Birthdate
*
Participant Ethnicity / Race
*
For Grant Purposes Only
Parent / Guardian Name
*
Relationship To Participant
*
Cell
*
E-mail
*
Emergency Contact 1
*
Emergency Contact 2
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Medical Information
N/A If Not Applicable
Is your Youth Currently Being Treated For an injury, sickness, or taking any medications if so please explain.
*
Has Your Child Ever Experienced any of the Following?
*
Asthma
Diabeties
Heart Murmurs
Hay Fever
Seizures
Kidney diesease
No
Other
Does Your Child Have a Physical Handicap That May Prevent Them for Participating in Rigorous Activity if so please explain.
*
Family Doctor Information
Name, Phone Number
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School Information
School Attending
*
GPA
*
How did you hear about us?
*
Please Select
Newspaper
Internet
Magazine
Friend
News
Event
Advertisement
Other
Academic Awards / Extracurriculars
List Below
Essay Upload
Why do you want to be part of the Y.I.A. Program? Please share your thoughts in an essay of at least 200 words. Explain your reasons for wanting to attend, including how you believe the camp will benefit you personally and professionally. Feel free to discuss your interests, goals, and how you think participating in this camp will contribute to your growth and development.
*
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(OPTIONAL) Additional Documents - Recommendation Letter etc.
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Please note that after you have been accepted there will be a mandatory zoom call that will highlight the expected criteria and scheduled calendar activities.
Participant Signature
*
Parent / Guardian Signature
*
Date
*
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Month
-
Day
Year
Date
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