1. VALLEY GUARDIANS EXECUTIVE LEADERSHIP PROGRAM APPLICATION

VALLEY GUARDIANS EXECUTIVE LEADERSHIP PROGRAM APPLICATION
Description of Program
The Valley Guardians Executive Leadership Program is a success coaching program designed for students with financial needs. It was created by the Valley Guardians, a group of Phoenix Valley philanthropists, committed to supporting underserved
populations. The Valley Guardians support programs like this by collecting donations from business leaders in the Valley. This program is a multi-year opportunity to help students become happier, more successful, and plan for their futures. The scholarship covers success coaching, academic assistance, technology, and any other financial needs that occur. We are looking for the top students who are motivated to improve themselves, have a thirst for knowledge, and want to develop a vision for their life.
Program Benefits
- One-on-One Student Coaching
- Parent Mentoring Support
- Activities (Workshops, Company Visits, weekend Getaways, Social Events, Community Service, and Formal Ceremonies)
- Internships
- Personal Development and Goal Setting Life Skills (Finding a Job, Basic Computer / Software Skills)
- Post-High School Preparation (Application for Financial Aid,
  getting Accepted into College/Trade School)
- Financial Assistance (on a case-by-case basis for students in need of supplies that directly help them to become successful)
How Will the Applicants be Selected?

Program acceptance and requirements are based on four major criteria:
- Criteria 1, Financial Need: Financial guidelines used to
  determine need are based on household size and monthly
  household revenue (see Table 1). Please note that being
  outside of these guidelines does not necessarily disqualify
  you from acceptance.
- Criteria 2, Extenuating Circumstances: Foster care, Adoption, Single-Parent Home, Medical Issues, Emotional Trauma, etc.
- Criteria 3, Academic Excellence: GPA, accomplishments, desire.
- Criteria 4, Parent & Student Participation (See Table 2).
What is this application process?

- Applications will be accepted year around. - Once the application is completed, please submit to Team@LeadAZ.org and a representative will contact you within 48 hours to schedule a separate virtual/phone interview with the child applicant and parent.
Section 1: Guardian and Child Applicant Information (Must be filled out by a parent/guardian)
Guardian Information
First and Last Name
Email
example@example.com
Phone
Address address city state zip code
Relation to Child Applicant
Child Information
First and Last Name
Email
example@example.com
Phone
Birthdate

MonthDayYear
Date
Grade
School
Current GPA
Excitement to participate in the leadership program (not excited, neutral or excited)
Please give a short description to help us better get to know the child applicant and any difficulties they have experienced (foster care, adoption, divorce, medical issues, trauma, disorders, family issues etc)
Section 2: Household and Financial Information (Must be filled out by parent/guardian)
# Of people in Household
Total Household Monthly Income
Are you receiving government nutrition assistance (SNAP) or free/reduced lunch?

YesNo
Are you receiving government healthcare assistance? (AHCCCS)

YesNo
Are you in any other programs or services for individuals in financial need? If yes, please list the programs.

YesNoOther
FINAL SIGNATURE
I swear under penalty of perjury that the statements and documents provided about myself and persons in my home including information about school GPA, household financial information and the child applicant information are true and correct to the best of my knowledge, and that I have not withheld information. I, the undersigned parent, guardian, or legal representative, indicate that I have read this document and provide my consent for the application into the Valley Guardians' Executive Leadership Program for the aforementioned child and I represent that | am at least eighteen (18) years of age and am fully competent to sign this Release, and all household and financial information is accurate and can be verified.
Print ParentGuardianRepresentative
Child Applicant
ParentGuardianRepresentative Signature

Clear
Child Applicant Signature

Clear
Date

MonthDayYear
Date
Date

MonthDayYear
Date
Visit LeadAZ.org for more information or email Team@Leadaz.org for questions
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VALLEY GUARDIANS EXECUTIVE LEADERSHIP PROGRAM APPLICATION

Description of Program

Program Benefits

How Will the Applicants be Selected?

What is this application process?

Section 1: Guardian and Child Applicant Information (Must be filled out by a parent/guardian)

Guardian Information

Child Information

Section 2: Household and Financial Information (Must be filled out by parent/guardian)