Leadership Hot Springs Youth Program Nomination Form
School
*
Please Select
All Children's Academy
ASMSA
Christian Ministries
Cutter
Fountain Lake
Gospel Light Christian School
Homeschooled
Hot Springs
Jessieville
Lakeside
Lake Hamilton
Mountain Pine
Nominated By:
*
First Name
Last Name
Nominator's Email
*
example@example.com
Nominator's Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Student Name
*
First Name
Last Name
Suffix
Grade (upcoming school year)
*
Please Select
10th Grade
11th Grade
12th Grade
Student's Email
example@example.com
Parent/Guardian's Name
Parent/Guardian's Email
example@example.com
Parent/Guardian's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Submit
Should be Empty: