Ardmore Youth Leadership Application

Program Background and Activities
Did you apply for the Ardmore Youth Leadership Program last year?
How did you hear about the Ardmore Youth Leadership Program?
Activities/Organizations
Where do you hope to be in six years and what will you have accomplished?
What qualities can you contribute to the program?
Essay
The Ardmore Youth Leadership Program is designed to develop students who are passionate about making a positive difference in their schools and communities. In 250–350 words, respond to the following prompt:

If you could change any one thing in your school or community, what would it be? How would you make that change? Outline a realistic plan of action to achieve your goal.
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Youth Commitment
I understand that if admitted to the Ardmore Youth Leadership Program, I am filling a space that will not be available to another applicant. Therefore, I am expected to attend all program sessions (with expectations for illness, and emergencies) and complete 20 hours of community service in order to successfully complete the Youth Leadership Program. I am truly committed to the program and will strive to be a valuable participant.
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

Parent Approval
I have read the information of Youth Leadership Program and I approve of my child's participation. I hearby release and hold harmless the Chamber Foundation, its members, agents, employees or any individuals involved in the planning, organization or presentation of Youth Leadership Program programming for any accident, injury, illness, or any damage whatsoever related the above-mentioned student's attendence or participation in any activity or session of Ardmore Youth Leadership.
Parental Approval - Name of Parent/Legal Guardian
Relationship to Applicant
Signature of Parent/Legal Guardian
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

Program Cost & Scholarship Assistance
The Youth Leadership Ardmore program fee is $100. Scholarships are available for students who may need financial assistance.
Would you like to be considered for a scholarship?

Photography / Media Release

Parent / Guardian Approval ONLY
Throughout the Youth Leadership Ardmore program, participants may be photographed and/or recorded during program sessions, tours, activities, community events, and other Youth Leadership functions. These photos and videos may be used by the Ardmore Chamber of Commerce for promotional and informational purposes, including social media, the Chamber website, newsletters, publications, press releases, and other print or digital materials.

Because participants may appear in multiple photos and videos throughout the program year, the Ardmore Chamber of Commerce requests permission to use the participant’s image and/or likeness in these materials.

This section must be completed by the participant’s parent or legal guardian.
Applicant Name
Parent / Legal Guardian Name
Signature of Parent / Legal Guardian
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

Reference Form

If you would like someone to submit a reference on your behalf, please send them the link below. References are optional and are not required to apply.

[REFRENCE FORM]
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Parent Information