2026-2027 Youth Leadership Application

2026-2027 Youth Leadership Application

Please review all program information thoroughly before submitting your application.
MISSION STATEMENT:

Youth Leadership Dothan – Houston County is a county-wide leadership training program for high school juniors who have demonstrated leadership skills. The program prepares the individual for constructive leadership, committed involvement and responsible participation in the future of our community.

Youth Leadership Dothan – Houston County is a program of the Dothan Area Chamber Foundation.

INFORMATION FOR 2026-2027 APPLICANTS:

Please carefully review the information below before completing your application - particularly the Program Calendar. Attendance at all sessions is essential, and full participation is expected. Before applying, please confirm that you are not aware of any conflicts with the scheduled dates.

Students who are dually enrolled must receive prior approval from their Wallace Community College instructors to participate in the program. Absences due to dual enrollment classes or athletic practices will not be considered excused.

ELIGIBILITY REQUIREMENTS:
- At least 15 years of age and a current high school junior
- Attend a high school in Dothan or Houston County
- Approval of your high school principal
- Homeschool applicants must be affiliated with a local homeschool association & reside in Houston County
- Demonstrate leadership in school and/or community activities
- Have an interest in addressing the issues confronting your community
- Commit to full participation in the program
- Be academically sound; an average of “C” or better is recommended as the program will require students to miss seven days of class (one day per month)
- One non-family member reference must be submitted on your behalf using the supplied form
- Applications & references must be submitted by 5pm on Wednesday, September 9th, 2026. NO EXCEPTIONS.
INTERVIEWS:

All applicants are required to participate in an interview with the Youth Leadership Dothan-Houston County selection committee. Interviews will take place on September 22 and 23 between 5:00 and 8:00 p.m. Applicants will be notified of their scheduled interview time by September 16. Please note that interviews will only be conducted during this designated time frame; alternate dates will not be available. Interview appropriate attire is requested.

TUITION & TUITION ASSISTANCE:
- The cost to each participant is $375.
- This program is sponsored by the Dothan Area Chamber Foundation. If you are in need of financial assistance, please contact Jessica Steltenpohl at the Dothan Area Chamber of Commerce: (334) 792-5138 or jessicas@dothan.com
TRANSPORTATION:

Students are responsible for their own transportation to and from the assembly point of each Program Day. Transportation throughout the day may be provided by the Youth Leadership Dothan-Houston County Program.

SCHOOL APPROVAL:

The school reserves the right to withdraw the student from the program for academic and/or disciplinary reasons at any time. Upon acceptance into Youth Leadership Dothan-Houston County, the Chamber will contact your school to verify attendance, grade point average and school approval for you to participate in the program. Homeschool applicants must provide documentation of grade level and grade point average from their homeschool association. Tuition is non-refundable.

ATTENDANCE COMMITMENT:

To successfully complete the Youth Leadership Dothan-Houston County Program and receive a graduation certificate, a participant is expected to attend 6 sessions AND the community service project selected by the class. Attendance at the opening retreat and community service project are MANDATORY.

An excused absence will be granted only for family emergencies or illness. If a student misses more than one session, they are welcome to complete the program, but they cannot be recognized as a graduate of the Youth Leadership Dothan-Houston County Program. Athletic practices will NOT be excused. Tuition is non-refundable.
By signing below, I acknowledge and agree to the attendance commitment.
APPLICANT INFORMATION

Let’s start with the basics - tell us about yourself!
Student's Name

First NameLast Name
Student's Mailing Address

Street Address

Street Address Line 2

CityState / Province

Zip Code
High School
Student's Email Address (Please use the email address you check regularly. Double check for accuracy.)
example@example.com
Student's Cell Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Age
Gender
Race
T-Shirt Size
Please list any food allergies or dietary restrictions
ORGANIZATIONS / CLUBS / TEAMS

List 3 of your school, volunteer, religious, social organizations, clubs and/or any athletic teams in which you have participated during the last four years. Please do not abbreviate organization, club or team names.
1. Name of organization, club or team
Grade(s):
Responsibility/Involvement
2. Name of organization, club or team
Grade(s):
Responsibility/Involvement
3. Name of organization, club or team
Grade(s):
Responsibility/Involvement
SCHOOL & COMMUNITY ACTIVITES RECOGNITION

List up to three special awards, honors or recognitions for academic, school or community related activities you have received from the 8th-10th grades:
1. Recognition #1
2. Recognition #2
3. Recognition #3
STUDENT WORK EXPERIENCE

List any part-time job experience, paid or unpaid, and briefly describe your role. Please start with your most current employer.
Are you currently employed?
Employer
Length of Employment
Title/Responsibilities
Average number of hours worked per week
Employer #2
Length of Employment
Title/Responsibilities
Average number of hours worked per week
TELL US A LITTLE MORE...

We’re excited to learn more about you! Take a few minutes to share your thoughts and help us get to know you better by answering the questions below.
Please list the top 3 career choices that currently interest you the most:
Describe yourself in one sentence.
What session on the Program Calendar interests you the most? (Program Calendar is posted at the top of the form)
What is one local issue in the City of Dothan or Houston County that you would like to learn more about?
ESSAY: In 250 words or less, we’d love to hear your thoughts in your own words- straight from you (not from ChatGPT or any other AI) to the following question:

If you could change anything in our community, what would you change and how would you accomplish it?
ESSAY RESPONSE:
PARENT/GUARDIAN INFORMATION
Mother/Guardian's Name

First NameLast Name
Mother/Guardian's Email
example@example.com
Mother/Guardian's Preferred Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Mother/Guardian's Employer
Father's Name

First NameLast Name
Father's Email
example@example.com
Father's Preferred Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Father's Employer
PARENTAL PERMISSION
- I am the parent or legal guardian of the above-named student and grant full permission for my child to participate in all sessions and activities of the Youth Leadership Dothan-Houston County Program during the school year in which they are a participant.
- I authorize Youth Leadership Dothan-Houston County, its agents, employees, and representatives to provide transportation for my child by public service bus, private automobile, van, or other appropriate means as needed throughout the program.
- I understand that students are responsible for arranging their own transportation to and from the designated assembly point of each Program Day. In some instances, students may be required to drive themselves. If my child chooses or is required to drive their own vehicle, they do so voluntarily and at their own risk. I acknowledge that neither Youth Leadership Dothan-Houston County, the Dothan Area Chamber Foundation, the Dothan Area Chamber of Commerce, nor any affiliated schools, staff, volunteers, or partners shall be held liable for any injury, accident, illness, or damage that may occur during personal travel to and from program activities.
- Furthermore, I release, indemnify, and hold harmless all aforementioned parties from any and all claims arising out of or connected to my child’s participation in Youth Leadership Dothan-Houston County. I also authorize the release of my child’s name and address to educational institutions for program-related purposes.
- I, the parent or legal guardian of the minor named in the application, give permission for the Dothan Area Chamber of Commerce and its affiliated programs to photograph or video my child during program activities. I authorize these images to be used for promotional purposes, including social media, websites, and printed materials, without compensation.
  
  I understand the images may be publicly accessible and waive any right to inspect or approve the final materials. This consent remains in effect for the duration of my child’s participation unless revoked in writing.
Parent/Guardian's Name

First NameLast Name
Relation to student
Parent/Guardian's Preferred Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian's Email Address
example@example.com
Parent/Guardian's Signature
REFERENCE

Each applicant is required to submit one reference form from a non-family member. Applications without a completed reference form will not be considered.
PRO TIP: Download the Reference Form early and send it to your selected reference. Ask them to return the completed form to you a few days before the September 9 deadline so you have time to upload it with your application.

Your application is not considered complete unless the completed Reference Form is uploaded and received. It is the applicant’s responsibility to make sure the form has been returned, uploaded correctly, and included with the application before the deadline. Late or incomplete applications will not be accepted

Reference Forms may be downloaded and shared with your reference by clicking on the "download icon" below (the downward-pointing arrow with a short horizontal line underneath it, next to the printer icon).
One reference is required for your application to be considered complete. All applications and reference forms must be submitted by September 9, 2026 at 5:00pm. It is the applicant’s responsibility to ensure that the reference form has been received and submitted by the deadline.

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HOW THE SELECTION PROCESS WORKS:
- All applicants are required to participate in an interview with the Youth Leadership Dothan-Houston County selection committee.
- Interviews will take place on September 22 and 23 between 5:30pm and 8:00pm at the Dothan Area Chamber of Commerce, located at 102 Jamestown Blvd. in Dothan.
- Applicants will be notified of their scheduled interview time by September 16. Please note that interviews will only be conducted during this designated time frame; alternate dates will not be available.
- Interview appropriate attire is requested.
- Applicants will be notified of their acceptance by October 9, 2026.
- A reception for selected applicants and one parent/guardian will be held on Sunday, October 18th at 3:00pm.
Thank you to our 2026-2027 Youth Leadership Dothan-Houston County Sponsors:

& Church at the Crossing
Should be Empty:

2026-2027 Youth Leadership Application

APPLICANT INFORMATION

PARENT/GUARDIAN INFORMATION

PARENTAL PERMISSION

REFERENCE