2026-2027 Claude Moore Community Builders (CMCB) Application

2026-2027 Claude Moore Community Builders (CMCB) Application
Thank you for your interest in the Claude Moore Community Builders Program! Please read the following directions carefully before completing the application.
Application open dates: Saturday, March 21, 2026 to Saturday, April 11, 2026

CMCB program dates: June 2026 to March 2027

This application is for students who have never been a participant of the CMCB program.

Your application requires 1 recommendation in order to be considered. It must be submitted by the closing of the application, April 11, 2026. Link to recommendation form: https://forms.gle/197FNSwAnEi1iysU6 Recommendation requirements are on slide 6 of CMCB program policies (link below)

If your application passes the first round of review, you will be invited to a short interview with the CMCB program coordinator.

CMCB program policies: https://docs.google.com/presentation/d/1kmisFh8PnXltcfkj6xz7fjjjnBIel8ttZj-p8HAH7_A/edit?usp=sharing

Please complete this application on your own using your own words. We want to see who you are as a student and volunteer!
Yes, I applied but was put on a waitlist due to limited space.No
YesNot yet, but I will send the following link to them now: https://forms.gle/197FNSwAnEi1iysU6
YesNoNot sure
PART 1: General Information
Applicant First Name*
Applicant Last Name*
Applicant Email (no LCPS email addresses, please)*
Applicant Cell Phone*
Applicant Home Phone
She/herHe/himThey/themOther
Parent/Guardian First Name*
Parent/Guardian Last Name*
Parent/Guardian Email*
Parent/Guardian Cell*
Street Address Line 1*
Street Address Line 2
City/Town*
VirginiaOther
Zip Code*
LoudounOther
High School you will attend NEXT YEAR (2026-2027)*
If you selected "Other" in the previous question: please write the high school you will attend next year (2026-2027)
10th11th12th
Age you will be when the program begins on June 13, 2026*
YesNoNot sure
PART 2: Current Volunteer Experience & Skills
List the volunteer experiences you have participated in so far (in or out of school). Include specific details such as how long you volunteered, how often you volunteered, and your role(s). Complete sentences are not required.*
Working with people with special needsGraphic designVideo productionSocial media content creation (Instagram, TikTok, Facebook, etc)None
If you selected any options in the previous question, please describe your experience here with specific details such as how long you have been involved. Complete sentences are not required. If you selected "None", please write "N/A".*
List 3 skills you possess that make you a good candidate for this program.*
Choose 1 skill you listed in the previous question and describe in 2-3 sentences why it makes you a good candidate for this program. *
Are you fluent in any other language(s) in addition to English? Please list them below. If not applicable, write N/A.*
PART 3: Current & Future Commitments
YesNo
Do you have plans already scheduled for this summer (i.e. camps, internships, family travel, etc.)? If so, what are the approximate dates?*
Do you plan to participate in extracurricular activities during the 2026-2027 school year? If so, please list the activities and the approximate number of hours you expect to commit to them. *
PART 4: Future Volunteer Experience
IndoorsOutdoorsIndependentlyAs part of a small teamAs part of a large group
Working with childrenWorking with children with special needsWorking with adultsWorking with adults with special needsWorking with seniorsWorking with seniors with special needs (i.e. memory loss)Working with animalsBeing a camp counselorVolunteering at an afterschool programVolunteering at community eventsLearning about/educating people about sustainable agriculture at a community farmHelping individuals with disabilities work at a community farmGardeningCreating, prepping, or facilitating art projectsAssisting with theater productionsAssisting in pre-k summer programsTutoring studentsRaising awareness of mental health issues/suicide preventionSorting/organizing donations & helping at a thrift shop benefiting nonprofitsOffice administrative work (filing/sorting mail, stuffing envelopes, sending emails, etc.)Helping an organization boost its social media presence on Facebook, Instragram, Tik-Tok, etc.Journalism (research, writing, interviews)Helping an organization with community engagementAssisting with event planning & marketingAssisting with equine therapyVolunteering at a food pantryVolunteering as a tour guide at a museum/historic siteEngaging in historical preservationSupporting disability rights/services/educationAssisting with an art therapy programAssisting with a music therapy programHelping prepare food for people in needVolunteering at equine events (not working with the horses)Helping a literacy organization
Are there any specific nonprofit partners you would be interested in working with during the CMCB program? If so, please list them below. (optional)
YesNo
PART 5: Essay & Video Questions
The CMCB program requires commitment to complete 100 volunteer hours from June 2026 to March 2027. How do you plan to manage your time so you can be physically and mentally present at volunteer events and trainings? (150 word minumum, 200 word maximum)*

0/200
Please record and submit a video of up to 3 minutes to answer the following questions in your own words (and your own voice): Why do you want to participate in the CMCB program? What makes you unique as a person, student, or volunteer? What qualities does a good volunteer possess?*

Cancelof
PART 6: Demographic Questions

As a nonprofit organization, Loudoun Youth, Inc. (LYI) depends on grants and donations to run our programs. Some of our funders require us to include demographic data about the people we serve in our funding applications. All collected data will be reported as aggregate statistical findings and will not identify individuals. Your personal information will only be seen by LYI staff. We would appreciate your cooperation in helping us collect this data by completing the section below. The options for some of these questions were provided by our funders. Please help us continue to raise funds for our programs by selecting the best answers to these questions. Thank you!
20147 (Ashburn)20148 (Broadlands)20165 (Cascades)20166 (Dulles)20189 (Dulles)20158 (Hamilton)20175 ( Leesburg)20176 (Leesburg)20180 (Lovettsville)20117 (Middleburg)20118 (Middleburg)20129 (Paeonian Springs)20132 (Purcellville)20141 (Round Hill)20152 (South Riding)20164 (Sterling)20105 (Stone Ridge/Aldie)Other
FemaleMaleNon-binaryPrefer not to answer
HispanicLatinoNot Hispanic/LatinoPrefer not to answer
Asian, Asian IndianBlack, African AmericanNative Hawaiian or other Pacific IslanderWhiteOther
10-1718-24
FriendFamily MemberLCPS Teacher, Counselor, or other staff memberPTA/PTOSchool ClubLoudoun Youth NewsletterPeachJarFacebookInstagramTwitterNewspaperLoudoun Youth, Inc. websiteOther
PART 7: Agreement to Follow CMCB Policies & Parent/Guardian Permission to Apply

Please read the Claude Moore Community Builders Guidelines found here: https://docs.google.com/presentation/d/1kmisFh8PnXltcfkj6xz7fjjjnBIel8ttZj-p8HAH7_A/edit?usp=sharing

For your application to be considered, you must indicate that you agree with both statements below. *

Rows	Agree
I have read the 2026-2027 CMCB Guidelines found here: https://docs.google.com/presentation/d/1kmisFh8PnXltcfkj6xz7fjjjnBIel8ttZj-p8HAH7_A/edit?usp=sharing
If admitted to the CMCB program, I will abide by all of the policies explained in the Guidelines and I understand that non-compliance will result in dismissal from the program.

A parent/guardian must complete this section and type their name in the question below. *

Rows	Agree
I understand that the applicant is applying to the Claude Moore Community Builders program with Loudoun Youth, Inc.
I have read the 2025-2026 CMCB Guidelines found here: https://docs.google.com/presentation/d/1kmisFh8PnXltcfkj6xz7fjjjnBIel8ttZj-p8HAH7_A/edit?usp=sharing
I understand that participation in the CMCB program requires a considerable time commitment.
I have discussed the program's requirements with applicant and understand that failure to comply with the program's guidelines will result in dismissal from the program.
I have reviewed the responses to all the questions in this application and, to the best of my knowledge, the information provided is complete and accurate.

Name of Parent/Guardian agreeing to statements above*
Date*

MonthDayYear
Should be Empty:

2026-2027 Claude Moore Community Builders (CMCB) Application

Thank you for your interest in the Claude Moore Community Builders Program! Please read the following directions carefully before completing the application.

PART 1: General Information

PART 2: Current Volunteer Experience & Skills

PART 3: Current & Future Commitments

PART 4: Future Volunteer Experience

PART 5: Essay & Video Questions

PART 6: Demographic Questions

PART 7: Agreement to Follow CMCB Policies & Parent/Guardian Permission to Apply