Please return three copies to your school office no later than 12:00 pm on Wednesday, May13th.
“Class of 2016”
NATIONAL COUNCIL ON YOUTH LEADERSHIP
ELECTRONIC APPLICATION Spring 2015
Complete the information below and submit 3 hard copies as designated in your NCYL letter. Please staple
one photo to only one copy of the application.
1. PERSONAL INFORMATION
Full Name (as it should appear on your certificate):
Name as it should appear on your name tag:
Please spell your first and last name phonetically:
Male ____ Female ____
Home Address:
Phone:
e-Mail Address:
Parent/Guardian Name & Address:
Parent/Guardian Phone:
Parent/Guardian e-Mail Address:
High School:
Current Cumulative GPA:
College (or Occupation) choice following graduation:
Any Special Needs (be specific):
Publicity
Photo Release (please sign):
I give my permission for __________________________________________________to be photographed and/or interviewed
(Student's Name – Please Print)
by the news media and/or by the National Council on Youth Leadership. I am committing to participate in the Personal
Interviews, Youth Salute, and Awards Ceremony.
Signed: ____________________________________________________________ Date: _________________________
(Student)
Signed: ____________________________________________________________ Date: _________________________
(Parent or Guardian)
“Class of 2014” NATIONAL COUNCIL ON YOUTH LEADERSHIP ELECTRONIC APPLICATION SPRING 2013
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Please return three copies to your school office no later than 12:00 pm on Wednesday, May13th.
2. EMPLOYMENT
Current employment (including number of hours per week):
Past employment (including number of hours per week):
3. COMMUNITY INVOLVEMENT
Please list specific community activities/organizations that you have been involved with outside of school. (Enumerate by
starting each item 1, 2, 3, etc.) Please note if this was a school-related community service.
4. RELIGIOUS ORGANIZATION ACTIVITY
Please list your involvement in any religious organization, especially leadership positions you may have held. (Enumerate by
starting each item 1, 2, 3, etc.)
5. SCHOOL INVOLVEMENT
Please mark grades you were involved in following activities. Please identify any leadership roles you held.
9
10
11
School Government
Specific Position Held or Honors Received
All-School Officer
Class Officer
Student Gov’t Activities (e.g. Prom,
Food Bank)
9
10
11
Publications
Specific Position Held or Honors Received
Literary Magazine Staff
Newspaper Staff
Yearbook Staff
Other (Be Specific)
Other (Be Specific)
9
10
11
Performance
Specific Position Held or Honors Received
All-State Band
All-State Chorus
All-State Orchestra
Art Club
Band
Chorus
Color Guard
Debate/Speech Events (Be Specific)
Drill/Dance Team
Drum Line
Jazz Band
Mime
Orchestra
Other Performance/Arts
“Class of 2014” NATIONAL COUNCIL ON YOUTH LEADERSHIP ELECTRONIC APPLICATION SPRING 2013
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Please return three copies to your school office no later than 12:00 pm on Wednesday, May13th.
School Plays
Show Choir
Small Group (Be Specific)
Small Group (Be Specific)
Thespians
Other (Be Specific)
Other (Be Specific)
Other (Be Specific)
Other (Be Specific)
9
10
11
Academics
Specific Position Held or Honors Received
Honor Roll
National Honor Society
Other (Be Specific)
9
10
11
Social Service
Specific Position Held or Honors Received
Care Communicator
REACH
SADD
Student Ambassador
Win With Wellness
Other (Be Specific)
9
10
11
Foreign Language
Specific Position Held or Honors Received
Club
Other (Be Specific)
9
10
11
Athletics
Specific Position Held or Honors Received
Baseball
Basketball
Cheerleading
Cross Country
Diving
Football
Golf
Intramurals
Pep Club
Soccer
Softball
Swimming
Team Manager
Tennis
Track
Volleyball
Wrestling
Other (Be Specific)
9
10
11
Other Organizations
Specific Position Held or Honors Received
FCA
FFA
Other (Be Specific)
9
10
11
Other School Related Activities or
Honors Not Listed Above
Specific Position Held or Honors Received
“Class of 2014” NATIONAL COUNCIL ON YOUTH LEADERSHIP ELECTRONIC APPLICATION SPRING 2013
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Please return three copies to your school office no later than 12:00 pm on Wednesday, May13th.
Please respond to the following two-part question in 500 words or less.
1. What are your strongest leadership skills and what are you doing to improve your weaker ones?
2.
How will you use your leadership skills to impact your future?
“Class of 2014” NATIONAL COUNCIL ON YOUTH LEADERSHIP ELECTRONIC APPLICATION SPRING 2013
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