Youth Leadership Conference Application
Please have your 2-4 minute video ready before you fill out your application.
Applicant Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Applicant Email Address
*
example@example.com
Applicant Cell Phone Number
*
Please enter a valid phone number.
May we communicate with you via text?
Yes
No
Date of Birth
*
-
Month
-
Day
Year
Date
School & Extracurricular Activites
School Attending
*
Current Year in School
*
Freshman
Sophomore
Junior
Senior
GPA
*
Participation in extracurricular activites
Membership in organizations
*
Honors and recognitions received
*
Other activities
*
Parent/Guardian Information
Parent/Guardian Full Name
*
First Name
Last Name
Parent/Guardian Email Address (for approval request)
*
example@example.com
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Recommendations
Two academic references are required for your application. Please provide the name and e-mail address of a teacher or administrator at your CURRENT school that we may contact on your behalf.
Recommendation #1
*
First Name
Last Name
Recommender #1 Email Address (for recommendation request)
*
example@example.com
Recommendation #2
*
First Name
Last Name
Recommendation #2 Email
*
example@example.com
Video Submission
Attach a 2–4-minute video that introduces who you are, why you want to attend the conference, and describe a time when you worked with others to solve a problem or help someone in need.
Attach Your Video (required).
*
Upload a File
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How did you hear about the Youth Leadership Conference?
I affirm that all of the information provided on this application is correct.
*
Yes
No
I agree to participate in the Youth Leadership Conference on the scheduled dates, July 6-10, 2026, should I be selected.
Yes
No
Submit Application
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