2024-2025 Jr. Ambassador Application

This program is open to 11th grade students in the Charlotte area with a cumulative GPA of 3.0 or higher.

Do you live in the Charlotte or surrounding counties?*

YesNo

Are you in the 11th grade?*

YesNo

Do you have a cumulative weighted 3.0 GPA or above?*

YesNo

Name*

First NameLast Name

Email*

Confirmation EmailPlease provide a personal email. Do not use your school email address.

Phone Number*

Please enter a valid phone number.

City/State*

Street Address

Street Address Line 2

CityState / Province

Gender*

High School*

If home school, enter home school

Select the county where your high school is located*

Enter County *

Cumulative weighted GPA*

Parent/Guardian's Name*

First NameLast Name

Parent's/Guardian's Email*

Confirmation Emailexample@example.com

Parent's/Guardian's Phone Number*

Please enter a valid phone number.

Can you meet in person every Second or Third Saturday from 10am - 4pm?*

Yes, I am available every second or third SaturdaysI have conflicts but I can work them outI am not available on second or third Saturdays

Describe your second or third Saturday conflict

Can you meet for 1 hour virtually on Mondays and Tuesdays between the hours of 5pm and 8pm?*

Yes, I am available with no conflicts all yearI have conflicts but I can work them outI am not available

Describe your Monday/Tuesday Meeting conflict

Can you travel on the mandatory International Service Trip in June 2025 or July 2025*

Yes, I am available to travel on the International Service Trip in June 2025 or July 2025I have a conflict but I am confident I can work it outI am not available

Describe your International Service Trip in June 2025 or July 2025 conflict

Do you play sports?*

YesNo

Please provide the schedule for your practice and games, including the days and times.

Do you participate in any extracurricular activities besides sports?*

YesNo

Please provide a list of your extracurricular activities for the year.

Have you held any leadership roles in the last 2 years*

Yes, several leadership positionsYes, one leadership positionNo

Describe your past and current leadership roles.

Include titles/positions/offices (ie president, community service chair, etc.) where applicable.

Have you participated in any YBLA activities in the past?*

YesNo

List the YBLA activities have you participated in before

Include titles/positions/offices (ie president, community service chair, etc.) where applicable.

Have you completed any community service activities in the past 12 months?*

Yes, more than 20 hoursYes, between 1 and 19 hoursNo

List an overview of your community service activities in the past 12 months, include a description and number of hours.*

Please upload a picture/screenshot of your most recent grades that includes your cumulative GPA.*

Screenshot must show your name, date, and cumulative GPA to be valid.

Please upload a recent headshot of yourself.*

Total Scored

How did you hear about the YBLA Ambassador program?*

Ambassador's Name

First NameLast Name

Please describe

2024-25 YBLA Jr. Ambassador Application - Charlotte Area