Youth Lead Application Form

Youth Lead Application Form

We will need signatures on this form when we meet in person at Orientation
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
E-mail*
example@example.com
School*
Grade (as of Fall 2025)*
Gender*

MaleFemale
Birthdate*

MonthDayYear
Which Indian languages can you speak proficiently, if any?*
Parent/Guardian #1 Name*
Parent/Guardian #1 Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian #1 Email*
example@example.com
Parent/Guardian #2 Name
Parent/Guardian #2 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian #2 Email
example@example.com
Do you have previous work, internship, or volunteer experience?*

YesNo
Organization/Business #1
Start Date

MonthDayYear
Supervisor
Supervisor Email
example@example.com
Roles and Responsibilities (50-75 words)
Do you have additional experience you'd like to share?
Why do you feel you are a good fit for the ICA Youth "LEAD" Program? How will this experience benefit you? (up to 200 words)*
Are you available to travel to India?*

YesNoMaybe
Do you have or will you be able to obtain the proper documentation to travel outside of the United States (i.e. passport)?*

YesNo
Do you have or will you be able to obtain the proper documentation to travel to India (i.e. visa)?*

YesNo
Deposit Amount*

prevnext( X )
USDPlease complete the required $100 deposit to secure your spot in the Youth Lead Program.
Payment Methods

Fastlane Checkout

Choose from one of the PayPal options to make your payment.

Contact Info

Payment Info
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