Military Order of the World Wars (MOWW)
Arizona Youth Leadership Conference
APPLICATION
TO ATTEND THE MOWW ANNUAL YOUTH LEADERSHIP CONFERENCE (AZYLC) TO BE
CONDUCTED AT Glendale, AZ ON THE CAMPUS OF ASU WEST, 14-18 JUNE 2016.
(Block print or type information)
Name
First
Middle
AGE
SEX: M
Last
F
2015/16 GRADE: 10 or 11
Circle one
Address
(
Street/PO Box
City
State
Circle one
)
Zip
Phone #
*E-Mail Address
Approval of Parent/Guardian
Date
Signature
Name of Parent/Guardian
First
MI
Last
(Please Print)
Approval of High School Instructor:
Date
Signature
Name of High School, Counselor/Instructor’s name & Title, EMAIL and Phone Number
The following information will be used to assign you to rooms, and groups. Please give as much data as
possible.
 Leadership positions you have held or now hold:
 Co-curricular/extra-curricular activities (sports, clubs, Pompom cheer, TA’s, NHS, etc:
 Short Term Goals:
(Use back of sheet if necessary)
 Long Term Goals:
(Use back of sheet if necessary)
 Where do you expect to be in 10 years?
* Student/Applicant Signature
----------------------------------------------------------------------------------------------------------------------------- --------------Sponsoring MOWW Chapter____________________
Approval:
Signature
Address
Approving Official Title
Phone