YLF Application

YLF Applicant First Name YLF Applicant Last Name

Address

Street Address City State / Province / Region ZIP / Postal Code

YLF Applicant Email

YLF Applicant Home Phone

YLF Applicant Cell Phone

Parent/Guardian First Name Parent/Guardian Last Name

Parent/Guardian Cell Phone

Parent/Guardian Email

Parent/Guardian Address (if different)

Street Address City State / Province / Region ZIP / Postal Code

Name of High School

Educator who recommended you

Areas of interest (studies)

Areas of interest (career)

Hobbies and sports activities (include years involved if applicable)

Extracurricular school activities and civic activities (include years involved if applicable)

Awards received

Why is it important you be selected for Leadership Fond du Lac?

Do you believe that your future depends on what you know or who you know? Why?

List three things that you want to change about your community. Why?

Share an experience that you’ve had in your life that has helped you see the importance of acknowledging and celebrating diversity.

Upload first letter of recommendation or email to hello@sophiapartners.org

Letters written by parents, guardians or family members will not be considered.

Upload second letter of recommendation or email them to hello@sophiapartners.org

Letters written by parents, guardians, or family members will not be considered.

Medical Information

YLF Applicant First Name YLF Applicant Last Name

Emergency Contact (1) First Name Emergency Contact (1) Last Name

Emergency Contact (1) Phone

Emergency Contact (2) First Name Emergency Contact (2) Last Name

Emergency Contact (2) Phone

List any medical concerns such as allergies, etc.

Zero-Tolerance Policy*

The Youth Leadership Fond du Lac (YLF) Program is committed to providing a safe learning experience for its participants and adheres to a zero-tolerance policy for substance abuse.

Should a school official, law enforcement agency or Youth Leadership Program authority suspect a Youth Leadership participant of illegal or illicit drug use, possession, or association, he/she will be subject to disciplinary action. This action may include a meeting with the participant, parents, and school officials. Dismissal from the Youth Leadership Program may occur.

Any behavior that leads to the possibility of a citation for underage drinking, driving under the influence and other alcohol-related offenses may result in dismissal from the Youth Leadership Program.

Any behavior that leads to a student being expelled from school will result in dismissal from the program.

I, the YLF Applicant, acknowledge that I have received and read the above drug, alcohol, and expulsion policy and that I agree to abide by its terms. I acknowledge that it is my responsibility to inform the Youth Leadership Fond du Lac Coordinator should any of the above situations occur.

Check here to indicate that you have read and agree to the zero-tolerance policy.

Transportation*

We, the YLF Applicant and Parent(s)/Guardian(s), understand that it is the responsibility of the Youth Leadership participant to arrange for transportation to and from all Youth Leadership Fond du Lac events and that Sophia Transformative Leadership Partners will not fulfill this function or take any responsibility for it.

Check here to indicate that you have read and agree to the transportation requirements for this program.

Injury Statement*

We, YLF Applicant and Parent(s)/Guardian(s), understand that the Youth Leadership participant will be financially responsible for any and all expenses incurred due to injuries sustained traveling between school and the program site.

Check here to indicate you have read and agree to accept this injury statement

Release from Liability*

We, the YLF Applicant and Parent(s)/Guardian(s), agree to hold Youth Leadership Fond du Lac harmless and waive our right to file a claim, pursue legal action or seek financial reimbursement from Sophia Transformative Leadership Partners, Youth Leadership Fond du Lac, its board members, employees or any volunteers associated with this program which aforementioned rights may arise out of participation in the program.

Check here to indicate you have read and accept the release from liability statement.

Photo Release*

We, the YLF Applicant and Parent(s)/Guardian(s), consent to the taking and/or use of photographs of myself/our child for promotional purposes by the Youth Leadership Program.

Check here to indicate that you have read and consent to the photo release statement.

Policy and Waiver Consent*

We, the YLF Applicant and Parent(s)/Guardian(s), have read and understood all of the above policy statements and agree to adhere to said policies.

Phone

This field is for validation purposes and should be left unchanged.

Apply for Youth Leadership

Fond du Lac:

Now accepting applications for the 2021-2022 school year!