Young Leaders Start Your Leadership Journey with IYL!
Young Leaders Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Current Grade
*
Please Select
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
College
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Guardian Full Name
*
First Name
Last Name
Guardian Email
*
example@example.com
Guardian Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship to Student
*
Mother, Father, etc.
Emergency Contact Name & Phone Number
*
How would you like to participate in IYL?
*
Please Select
Join an existing local Qabeela
Join the national virtual program
Help start a new Qabeela in my community
Not sure yet
Are you already connected with a local Qabeela?
*
Please Select
Yes — enter Qabeela name
No — please help me find one
If Yes, Enter the Qabeela Information (Optional)
Which Local Masjid, Islamic School, or Community Organization are You Associated With?
*
How did you hear about Inspiring Young Leaders?
*
Please Select
Mosque or Islamic school
Friend or family member
Social media
IYL website
Other
Which leadership skills are you most interested in developing? (Select all that apply.)
Public Speaking
Debate
Islamic Knowledge and Leadership
Civic Engagement and Advocacy
Community Service
Media, Podcasting, and Journalism
Career and College Preparation
Personal Development and Mental Wellness
Why do you want to join Inspiring Young Leaders? (Optional)
Program Participation, Check All Boxes
*
I understand that IYL offers 12 monthly leadership challenges and awards digital badges for successfully completed activities.
I understand that some challenges may involve in-person activities, while others can be completed virtually.
I agree to follow IYL's student code of conduct and treat fellow participants, mentors, and community members respectfully.
I understand that completing all 12 challenges is required to qualify for the annual certificate and personalized letter of recommendation.
Parent/Guardian Consent For participants under 18, require a parent or legal guardian to complete this section. (Check All Boxes)
*
I am the parent or legal guardian of the student named in this application. I authorize my child to register for the Inspiring Young Leaders program and understand that additional permission may be required for specific activities or events.
I agree to receive program updates, announcements, and information about my child's participation from IYL.
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