Please use the form below to participate in the Civic Leadership Certification program. The Pennsylvania Jaycees chapter which scores the most points in 2016 will receive free dues for 2017 (a $1,200 value). This form includes many program areas, it is not unusual to leave questions blank. Please refer to the PA Jaycees website to learn about accumulating points and substantiation documentation.

DISCLAIMER: Although we no longer require chapters to submit documentation along with the CLC, we ask that each chapter keep its own records for a period of no less than 3 years. By submitting the form you certify that: you are the person who is responsible for submitting your chapter’s Civic Leadership Certification (CLC or CERTs) and that, to the best of your knowledge, all the information on this form is true and correct. You and your chapter understand that you may be asked, at any time, to provide the appropriate documentation to substantiate claims on this form. If you or your chapter are unable to substantiate claims made; you or your chapter will receive appropriate sanctions which may include; disqualification from the CLC program, forfeiture of any CLC related awards and/or prizes, and/or revocation of the chapter’s Jaycee Charter.

IMPORTANT PLEASE READ: By clicking the Submit button below I certify that: I am the person who is responsible for submitting my chapter’s Civic Leadership Certification (CLC or CERTs) and that, to the best of my knowledge, all the information on this form is true and correct. I understand that my chapter maybe asked, at any time, to provide the appropriate documentation to substantiate claims on this form. If my chapter is unable to substantiate claims made on this form; my chapter will receive appropriate sanctions which may include; disqualification from the CLC program, forfeiture of any CLC related awards and/or prizes, and/or revocation of the chapter’s Jaycee Charter.