P.O. Box 216 ~ West Liberty, IA 52776 ~ Ph: (319) 627-4101 ~ Fax: (319) 627-4403 ~ E-Mail: baronoffice@Lcom.net
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18, 2014
PLEASE TYPE OR PRINT
Full Name: _________________________________________________High School_____________________________
Male ( ) Female ( )
Home Address/P.O. Box_____________________________________________ City __________________Zip________
Phone __________________________ E-Mail (required) _________________________________________________
Current Cumulative GPA: _______ What are your plans after High School?____________________________________
Special needs (please be specific): _____________________________________________________________________
Signed ___________________________________________ ** Date ______________________
(student)
** By signing this Application, I assure the Muscatine Area Council on Youth Leadership of the following:

I will participate in a Highland Photography portrait session, a MACYL interview, the Youth Salute Leadership
Seminar and the Youth Salute Awards Ceremony.

I have not engaged in any activities which would be considered in violation of my High School’s, or its National
Honor Society’s, Good Conduct Rule, or its equivalent. If I engage in any such activity now through my participation in the Class of 2015 Youth Salute, I will notify MACYL immediately.

I have completed these application materials accurately and on my own; the essays reflect my own thinking and not that of my parents/guardian or others.
I give my permission for ______________________________to participate in the National Council on Youth Leadership program, including being photographed and/or interviewed by the news media and/or by representatives of the National
Council on Youth Leadership.
Parent’s/Guardian’s Signature: _______________________________________________ Date __________________
Parents/Guardians Names as they should appear on Student’s Portrait Display:
______________________________________________________________________________________________
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For the Leadership Profile that accompanies your portrait, please list up to 10 activities, honors, achievements, etc. and the length of your involvement. (For example: Honor Society, Honor Roll, Student Council, Class
Officer, Band, Sports, Boy/Girl Scouts, Church Youth Group, 4-H, Paid Employment, Volunteer Work, etc.).
Space is limited, so please prioritize the activities and achievements that are most important to you.
Number of Years
Activity/Honor/Achievement of Involvement
1.
On a separate sheet of paper, please respond to any three of the four questions below. Each essay must be
100-150 words in length. Include your name and the name of your school on the page(s) of your essays.
1.
Describe an accomplishment of which you are most proud, and please explain why.
2.
If your best friend was asked what characteristics s/he most admires about you, what would that friend say, and why?
3.
What kind of people do you admire most, and what kind of people annoy you most?
4.
Describe a time when your integrity was challenged and how you handled the situation.
R:NCYL 2014 class of 2015 Application - 2015
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