Cooperative Youth Leaders 2026
Please fill out the form below.
Full Name
*
First Name
Last Name
Preferred name for name tag
*
Student Email Address
example@example.com
Mailing Address
*
Street Address
City
State / Province
Postal / Zip Code
Physical Address (if different)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Student Cell Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
High School Name
*
Are you a CTC student?
Yes
No
Date of Birth
*
-
Month
-
Day
Year
Date
Age
*
Grade
*
T-shirt Size
*
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M
L
XL
2X
3X
What activities are you involved in at school?
*
What activities are you involved in at your church and/or in your community?
*
What leadership roles do you hold at school, church, or in your community?
*
List any other honors or achievements. Which achievements are you most proud of?
*
What are your hobbies?
*
Tell us an interesting fact about yourself.
*
Give us a 30 second elevator speech explaining why you should be chosen.
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Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
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