Youth Leadership Application

2010

You may use this convenient on-line form to submit your Youth Leadership Application. Simply fill in each of the items on the application and click the submit button at the bottom of the form. We will acknowledge receipt of you application within 48 hours. You must also submit by mail or fax a signed copy of the Parent/Guardian Permission form. All first time applicants must also submit one reference letter.

Deadline for submission is Friday, February 26.

I. Personal Information

Full Name: 
Nickname:
Shirt Size:
Home Address 1:
Home Address 2:
City: State: Zip:
Home Phone: Cell Phone:

E-mail Address:

Date of birth: Age:

School:

Present Class: Freshman Sophomore Junior             

In what other activities are you currently involved? (athletics, clubs, churches, etc.) Please list and briefly describe if necessary.

Are you currently working? Yes No

If yes, where do you work? 

# of hours per week:
Responsibilities:

Describe any past work-related experiences.

Youth Leadership meets monthly fro May to December. will be determined by the consensus of the group. The meetings are held at Valley United Way, 3 Corporate Drive, Suite 501, Shelton from 5:00 – 6:30 p.m.

Are you able to attend meetings at this time throughout the 2010 year?
Yes  No

Would you have transportation to the meetings? Valley United Way is unable to provide transportation for meetings. 

Yes  No

Youth Leadership members attend a weekend “Teambuilding Retreat” at Camp Jewell in Colebrook, Connecticut in April and this is a mandatory activity for acceptance into the Program. This year's retreat will be held on Friday evening, April 9, all day Saturday the 10th and members will return to the Valley after noon on Sunday. Valley United Way will provide transportation for the retreat, and there is no cost to attend.

Are there any circumstances that will prevent you from attending?

Yes  No

If yes, please describe:

II. Community Service & Work Information

A. Why are you interested in becoming involved with the Youth Leadership Program?

B. What talents/skills would you bring to the Youth Leadership Program?

C. What do you think is the most pressing need in your community? For teenagers?

D. Describe your current volunteer experiences. Identify each organization, your responsibilities, and the length of time/number of hours you are involved.

E. Please indicate how you see your role as a volunteer in the community.

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You will receive confirmation of your application by e-mail within 48 hours.

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