Youth Leadership Academy

YLA Application

Individuals wishing to apply for admission to the Youth Leadership Academy should print and fill out the application below.

Admission

Each year sixth grade students are competitively selected based on their application, recommendations, student and family interviews, . With support of their families, students must remain gang free, drug free and academically inclined. Youth Leadership Academy cadets and parent/guardians are fully informed of the rules and regulations of the Program and agree to the condition of membership. Any infraction of the rules and regulations is subject to disciplinary action or dismissal from the program.

Youth Leadership Academy (YLA)

2010/2011 APPLICATION FORM

Deadline: Must be received at YLA Office by March 19, 2010.

To be completed by the student. Please print.

Student Name _______________________________________________________ Date of Birth::______________

Last First month/day/year

Student Social Security Number (optional) __________________________________________________________

Street Address ________________________________________________________________________________

City/State/Zip _________________________________________________________________________________

Telephone where student can be reached (_____) ______________________________

Best time to be reached _________________ Alternate telephone number (_____) ________________________

School Name ____________________________________________________________ Current Grade_________

With whom do you live? both parents ____ one parent ____ grandparent ____ guardian____

other ____ (please explain)______________________________________

Complete the following:

1. What are your goals in life, especially regarding work/career, and why?

2. Who is the person that has had the most impact or influence on your life ? What have you learned from him/her?

3. What do you like best about school and why?

4. What do you like least about school? How would you change what you dislike or improve the situation?

5. When you are not in school, what do you most enjoy doing to improve yourself?

6. Describe any responsibilities you have to help other people (at home, school, church, etc.).

7. Tell about a time when you had to help plan, organize or run something where you had to tell others what to do or get them to cooperate.

8. What is a leader? (Use one sentence)

Names of the persons sending recommendations:

Teacher/school official _________________________________________________ Phone#___________________

Other adult __________________________________________________________ Phone#___________________

If selected for this program, I agree that I will not participate in gang activities, that I will stay out of trouble at

school and where I live; that I will attend school when I am supposed to; complete homework on time, participate in

Academy activities, and remain committed for the entire length of the YLA program (7th through 12 grade).

Student’s Signature_____________________________________________ Date___________________

Application and all 3 recommendations may be submitted together or separately, but all must be received no later

than March 19, 2010 at: Youth Leadership Academy (YLA)

Elgin Community College

51 S. Spring St.

Elgin, IL 60120

INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED. IF YOU NEED HELP IN COMPLETING

THIS APPLICATION OR WANT MORE INFORMATION, PHONE (847) 214-6910.

PARENT/GUARDIAN

To be completed by the parent(s)/guardian(s). Please print.

Parent/Guardian name(s)________________________________________________________________________

last first

My child is: male _____ female_____

(Voluntary) White _____ Hispanic _____ Black, non-Hispanic _____ Pan-Asian _____

other_____ (please explain)________________________________________

If my child is selected for this program, I/we agree that I/we will support him/her in meeting the student requirementsof the Academy and that I/we will participate in Academy activities and fulfill program requirements.

I/we understand that he/she must be a legal resident of the U.S. to be eligible.

I/we also understand the income requirements and have attached the most recent federal income tax forms.

I/we also understand that we must reside in Community College District 509 to be eligible for this program.

I certify that to the best of my knowledge, the above information is correct. I understand that any falsified information will result in disqualification of the student applicant.

Parent(s)/Guardian signature _______________________________________________ Date________________

NOTICE OF NONDISCRIMINATORY POLICY

The Youth Leadership Academy admits students of any race, color, national and ethnic

origin to all the rights, privileges, programs and activities accorded to students at the

Academy. It does not discriminate in administration of its educational policies, admissions

policies, scholarship and loan programs, and athletic and other school administered

programs.

DEADLINE FOR COMPLETED APPLICATION:

APPLICATIONS MUST BE RECEIVED BY MARCH 19, 2010 AT:

Youth Leadership Academy (YLA)

Elgin Community College

Fountain Square Campus, Room 415

51 S. Spring St.

Elgin, IL 60120

INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED. IF YOU NEED HELP IN COMPLETING

THIS APPLICATION OR MORE INFORMATION CALL (847) 214-6910

FOR OFFICE USE ONLY

income verified______ 3 recommendations received______ 6th grade______

Community College District 509_____ USA legal resident_____

Elgin Community College

Youth Leadership Academy

2008-2009 RECOMMENDATION FORM

March 19, 2010 Deadline

Note: Three (3) recommendations are required.

Please Print:

Name of the student ____________________________________________________________________________

last first

Recommender Name ___________________________________________________________________________

last first

Recommender Position

teacher/school official_____ community person_____

Relationship to student ___________________________________ Title (if any)________________________

Home Street Address ___________________________________________________________________________

City/State/Zip Code ____________________________________________________________________________

Telephone at which recommender can be contacted (_______) _____________

Best time to be contacted ___________________________________________

Alternate telephone number, (if available) (_______) ____________________

Business address if applicable ____________________________________________________________________

Business Phone (______) ___________________________________________

RECOMMENDATION:

If you are recommending a student, please contact him/her to ensure that she/he has completed an application.

Please address each of the following:

LEADERSHIP POTENTIAL AND PERFORMANCE:

ACTIVITIES (SCHOOL, CHURCH, ETC.):

RESPONSIBILITIES OUTSIDE OF SCHOOL:

WHY SHOULD THIS STUDENT BE SELECTED?

Complete the following only if you are a teacher/school official

ACADEMIC PERFORMANCE, POTENTIAL, EFFORT, MOTIVATION:

Signature_______________________________________________________________

Date______________________________

DEADLINE FOR RECOMMENDATIONS

MUST BE RECEIVED NO LATER THAN MARCH 19, 2010 AT:

Youth Leadership Academy (YLA)

Elgin Community College

Fountain Square Campus, Room 415

51 S. Spring St.

Elgin, IL 60120

QUESTIONS? Contact 847-214-6910

YLA ELIGIBILITY / RESIDENCY REQUIREMENTS 2010-2011

Participation is based on the following criteria:

1. The students is a 6th grader in Community College District 509.

2. Verification by the student's school that the student is eligible for the free lunch or free milk program or verification that family income does not exceed specific guidelines (contact 847-214-6910 for guidelines).

3. Must stay in school.

4. Must be a legal resident of USA.

5. No trouble with the law or at school.

6. No participation in gang activities.

7. Sign the family contract.

CONTINUING REQUIREMENTS

1. Must continue to reside in Community College District 509.

2. Must stay in school.

3. No trouble with the law or at school.

4. No participation in gang activities.

5. Attend YLA training sessions.

6. Participate in Academy activities.

7. Participate in community service projects.

8. Establish specific academic, personal, career and Academy goals. (These may change throughout the program).

9. Cadet progress evaluated periodically to recommend continuation.

10. Graduate from high school.

REQUIREMENTS FOR ACADEMY FAMILIES

1. Ensure that the student goes to school, does homework and graduates from high school.

2. Take necessary steps to keep the student in school, out of trouble with the law and out of gangs.

3. Reinforce basic principles of good citizenship.

4. Work with the student to establish and accomplish academic, personal, career and Academy goals.

5. Provide transportation to/from the regular Academy sessions.

6. Participate in family Academy events.

7. Participate by example.

8. Sign the family contract.

9. Complete required financial aid forms for college entrance during the senior year in high school.

10. Always notify YLA of changes in address or phone and of legitimate reasons for absence of student from a

YLA session (phone: 847-214-6910).

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