Young Women's Leadership Academy- Scholar Application & Interest Form

Scholar's Name

First NameLast Name

Preferred Name

Birth Date

MonthDayYear

Grade (as of September 2026)

Primary Language

Other Languages?

Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Martha's Vineyard Physical Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Session Information & Selection

Please select your preferred session:

T-Shirt Size (Adult Sizes)

Parent/Guardian Information

Primary Parent/Guardian Name (Parent Registering/Primary Contact)

First NameLast Name

Preferred language for communication

Primary Contact Preferred Number (Please provide the cell number where you can be reached.)

Format: (000) 000-0000.

Primary Parent/Guardian E-mail

example@example.com

Secondary Parent/Guardian Name (if applicable)

First NameLast Name

Secondary Number (Please provide the cell number.)

Format: (000) 000-0000.

Secondary Parent/Guardian E-mail

example@example.com

Emergency Information

Emergency Contact #1- Name

First NameLast Name

Relationship

Phone Number

Format: (000) 000-0000.

Emergency Contact #2- Name

First NameLast Name

Relationship

Phone Number

Format: (000) 000-0000.

Emergency Contact #3- Name

First NameLast Name

Relationship

Phone Number

Format: (000) 000-0000.

1. What interests you most about YoWLA?

2. What are some activities, hobbies, sports, clubs, or interests that are important to you?

3. Tell us about something you care deeply about.It could be a problem you want to solve, a cause you care about, a person you admire, or something you wish was different in the world.

4. What do you hope to learn or gain from this experience?

5. What is one strength you bring to a group?

6. What is one thing you would like to become more confident doing?

7. If you could improve one thing in your school, neighborhood, or community, what would it be?

8. At YoWLA, we believe leadership comes in many forms. Which statements sound most like you? (Check all that apply.)

9. Imagine it is the last day of the Academy. What would make you say, "I'm really glad I did this"?

1. Why do you believe YoWLA would be a meaningful experience for your child?

2. Are there any strengths, interests, learning needs, or considerations you would like us to know about to best support your child?

Health & Medical Information (Optional)--Please share any allergies, medications, health conditions, dietary restrictions, or medical needs that you believe would be helpful for the YoWLA team to know when reviewing this application and planning for your scholar's participation.

Social, Emotional, Learning, or Participation Considerations (Optional)---Please share any social, emotional, behavioral, learning, communication, sensory, or participation considerations that may help the YoWLA team better support your scholar's success in a collaborative leadership and service-learning environment.You may also share strategies, accommodations, or supports that have been helpful in school, extracurricular activities, or other group settings.

How would you like to pay for the Academy Tuition? (Please note: Upon enrollment, an electronic invoice will be sent to the primary contact's email. Registration is not complete until no less than 66% of tuition is paid in full.)

PARENT/GUARDIAN ACKNOWLEDGEMENT

By acknowledging and signing below, I understand and agree that my electronic signature shall have the same legal effect and enforceability as an original handwritten signature.

I certify that I am at least 18 years of age and am the parent or legal guardian of the scholar identified in this application, with the authority to submit this application and make enrollment decisions on the scholar's behalf.

I acknowledge that the information provided in this application is complete and accurate to the best of my knowledge. I understand that the K/VAL Young Women's Leadership & Service Academy (YoWLA) may rely on the information provided in reviewing this application, planning for scholar participation, and supporting scholar safety and success.

I understand that submission of this application constitutes an expression of interest in enrollment and does not guarantee acceptance into the Academy. If accepted, I agree to complete any additional registration forms, waivers, health information, and tuition arrangements required for participation.

By signing below, I acknowledge that I have read and understand the information provided in this application and that all statements made are true and accurate to the best of my knowledge.

Name

First NameLast Name

Date

Signature

Young Women's Leadership Academy

Scholar Information

Getting to Know You

Parent/Guardian Reflection

Additional Information (Optional)

Application & Enrollment Process