Apply to Global Youth Leadership Academy

Applicant

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

School

School Name*

Graduation Year*

City*

State*

Student Contact

Address*

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

Home Phone

Cell Phone*

Email*

Enter Email Confirm Email

Parent/Guardian (multiple optional)

Parent/Guardian #1

Name*

First Last

Relationship to Student*

Phone*

Email*

Enter Email Confirm Email

Parent/Guardian #2

Name*

First Last

Relationship to Student*

Phone*

Email*

Enter Email Confirm 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

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?*

APPLY TO GLOBAL YOUTH LEADERSHIP ACADEMY

Applicant

School

Student Contact

Parent/Guardian (multiple optional)

Parent/Guardian #1

Parent/Guardian #2

Recommendation

Activities

Leadership

Global Youth Leadership Academy

Nominate a Student