2022 Youth Leadership Academy Application

Leadership Lake County has provided leadership development programs since 1987. The experiential nature of our program days and the preparation for workplace and community leadership roles are the hallmarks of our programs. It is a unique opportunity designed to guide students to reach his or her full potential.

Application Due Date: April 23, 2021

Applicants will be notified of their status by May 1, 2021

Class size is limited and late applications may not be considered.

Please note: Invoices for the $350 non-refundable participation fee will be issued with notification of acceptance. Need-based partial financial assistance may be available upon written request from the student participant. Do NOT send payment with application.

MONTHLY SESSIONS: The monthly all-day sessions begin August 2021 and end in April 2022 on the second Tuesday of each month unless otherwise noted. Program Days are from 7:30 am until 2:30 pm. There is no program day in January. Students may miss one non-mandatory day and remain eligible for graduation from the program. The schedule for 2021 - 22 is as follows:

2021

April 23 Application Due

May 11 Orientation and Tuition Due - (Tuesday 6:00 pm–7:30 pm)

August 10 Opening Retreat - Everyday Leadership - Mandatory

September 14 Leaders & Followers

October 12 Leaders & Followers

November 9 Communicating as Leaders

December 14 Turning Conflict into Cooperation

2022

February 8 Collaboration is Leadership

March 8 Motivating the Team

April 12 Closing Retreat and Graduation - Mandatory

First Name

Last Name

Name as it should appear on name tag (what do you like to be called)

Birthdate (mm/dd/yyyy)

Parent(s) Name

Parent(s) Email

Student Email (if applicable)

Parent(s) Mobile

Student Mobile (if applicable)

Home Address

City

Zip Code

Middle School

Grade for 2021-22 School Year

Select Grade

Demographic Information (for internal use only)

Sex

Select Gender

Male
Female
Trans
Prefer not to answer

Ethnicity

Select One

White
Asian
African American
Hispanic-Latino
Native American
Bi-Racial
Other

Dietary Restrictions/Allergies

Shirt Size

Select Size

Youth M
Youth L
Adult S
Adult M
Adult L
Adult XL
Adult 2XL

Parental Permission

I have read the information on the Youth Leadership Academy and grant permission for my child to participate in the Leadership Lake County Youth Leadership Academy of 2021. I hereby release and hold harmless Leadership Lake County Trustees, its members, agents, employees or any individuals involved in the planning, related to the above-mentioned student's attendance at or participation in any activity or session of the Youth Leadership Academy.

Parent Signature

To accept this contract, type your name below

Student Essay

Please answer the following questions in your own words.

Please state why you want to participate in the Youth Leadership Academy including your expectations and what you hope to gain from your experience in the program.

What are some of the challenges you face today at school and/or home and how do you think the skill development in the YLA program will help you better manage those challenges?

What is something you would like to accomplish before graduation high school? Why?

Organizations and Activities, Accomplishments, and Future Goals

Please answer the following questions in your own words.

Tell us about your participation in three activities and/or organizations in the past two years that are most important to you. This may include activities related to school, community, church, social, athletic, scouting, etc. Provide specific detail about what you did during your participation with the activities listed.

Please list any accomplishments, awards, honors, or recognition for academic, school, religious, or community-related activities you have received over the last two years.

In what types of careers do you see yourself in after high school?

What types of activities/ organizations/ clubs would you like to become involved or participate during the next 5 years?

Reference Letter

Your application requires that we receive one letter of reference from someone who knows you well outside of school.

The letter must include the name, complete mailing address, and phone number of your reference.

The letter should address the following: For how long and in what capacity have you known the applicant? Describe the applicant's leadership potential, including strengths and areas for growth. What distinguishes this applicant from other candidates you might recommend?

The letter must be received on or before April 23, 2021.

The letter may be scanned and uploaded via the link on the application page, emailed to dbillings@leadershiplc.org, or mailed to Youth Program Manager, Leadership Lake County, 8804 Mentor Ave., Mentor, OH 44060.

School Approval and Recommendation

All applicants must have the approval of their school principal to attend the program sessions of Leadership Lake County's Youth Leadership Academy. Please check with him/her about required attendance procedure. Please ask your principal to complete the form below.

2021 School Approval Form

School approval must be received on or before April 23, 2021.

Thank you for your application!

If you have any questions, please contact Debbie Billings at (440) 290-7933 or dbillings@leadershiplc.org.

Student Signature (type name below)

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2022 Youth Leadership Academy Application

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