6892199

Program You're Applying For

First Name*

Last Name*

Preferred Name/Nickname

Birthdate*

Gender*

Male
Female

Ethnicity

T-Shirt Size*

I have attended GYLA in the past and am registering for Y2

I am sponsored by:

If you are receiving a sponsorship, please let us know the sponsoring person or organization.

School

School Name*

City*

State*

Graduation Year*

Student Contact Information

Address*

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

Home Phone

Cell Phone*

Email*

Parent/Guardian Information

Parent/Guardian #1

Name*

First Last

Relationship to Student*

Phone*

Email*

Parent/Guardian #2

Name*

First Last

Relationship to Student*

Phone*

Email*

Recommendation

Provide the name and email address of a teacher, employer, coach or school counselor that will recommend you for our program.

Name

First Last

Email

How did you learn about GYLA?*

Internet
Counselor/Teacher
Friend/Family
Advertiser
Other

Name of person or place who told you about GYLA:

Please let us know who to thank for referring you!

Activities

Activities, clubs, hobbies in which you are currently involved in your school, home, church, community, etc.*

Leadership

List 3 leadership positions you have held in the past 3-5 years, or would like to hold in the future.

1)*

2)*

3)*

Why would you like to attend GYLA? What do you hope to gain?*

Is community service important in our world today? Why or why not?*

What does servant or heart-led leadership mean to you?*

School

Student Contact Information

Parent/Guardian Information

Parent/Guardian #1

Parent/Guardian #2

Recommendation

Activities

Leadership

Global Youth Leadership Academy

Nominate a Student