YLF Application - Sophia Partners

Student Information

Name*

First Name Last Name

Preferred Phone Number*

Email*

Address*

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

Name of High School*

Educational Areas of Interest*

Career Interests*

Extracurricular (sports, clubs, etc.) and Volunteer Activities, including years involved

Hobbies

Awards and Recognitions Received, if applicable

Why do you want to participate in the Youth Leadership Fond du Lac program?

Do you believe that your future depends on what you know or who you know? Explain your answer.

List three things that you want to change about your community. Explain your answer.

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

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

Parent/Guardian Information

Parent/Guardian Name*

First Name Last Name

Parent/Guardian Preferred Phone Number*

Parent/Guardian Email*

Parent/Guardian Address (if different from student)

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

Emergency Contact Name, if different from Parent/Guardian

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

Emergency Contact Phone, if different from Parent/Guardian

Emergency Contact (2) Name, if applicable

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

Emergency Contact (2) Phone, if applicable

List any medical concerns such as allergies, food, 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 Youth Leadership Fond du Lac 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 Statement*

We, the Youth Leadership Fond du Lac 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 statement.

Injury Statement*

We, Youth Leadership Fond du Lac 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/home and the program site.

Check here to indicate that you have read and agree to the injury statement.

Release from Liability*

We, the Youth Leadership Fond du Lac 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 that you have read and consent to the release from liability statement.

Photo Release*

We, the Youth Leadership Fond du Lac 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.

YLF Student Participation Agreement*

The Youth Leadership Fond du Lac (YLF) Program is an 8-month program designed for high school juniors who have been recommended to participate.

The 2023-2024 program will be held from 8:00 am - 2:45 pm on the second Monday of each month from October 2023 - May 2024. Students will meet at various locations within Fond du Lac County.

As a participant in Youth Leadership Fond du Lac, I agree to the following:
- Attend all programs/classes scheduled (one excused absence is allowed with prior approval from the director).
- Take responsibility for communicating with the Leadership Director and responding to emails.
- Provide my own transportation to and from all programs.
- Behave in a manner that is professional and appropriate during and outside of the program, while a member of this program.

Check here to indicate that you have read and agree to the student participation agreement.

Student Signature*

Demographic Information (optional)

Completion of this section is voluntary. No program participant selections are made based on this information. There will be no impact on your application if you choose not to answer any of these questions.

Gender

she/her
he/him
they/them

Ethnicity

Hispanic or Latino - a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.
American Indian or Alaska Native - a person having origins in any of the original peoples of North or South America (including Central America), and who maintains tribal affiliation or community attachment.
Asian - a person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, or Vietnam.
Black or African American - a person having origins in any of the black racial groups of Africa.
Native Hawaiian or Other Pacific Islander - a person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific islands.
White - a person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

Participation Accommodations

Please describe any accommodations you would need from the program in order to participate (ie: wheel-chair accessible, translator, etc.)

Comments

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

Apply for Youth Leadership

Fond du Lac:

Applications for the 2023-2024 school year will open soon!

2023-2024 Youth Leadership Fond du Lac Application

Student Information

Parent/Guardian Information

Demographic Information (optional)