July 20-27, 2019 -- Switzerland // July 29-August 5, 2019 -- Haiti

APPLY TO GLOBAL YOUTH LEADERSHIP ACADEMY

Applicant
First Name*
Last Name*
Preferred Name/Nickname
Birthdate*
Gender*
- Male
- Female
Ethnicity
T-Shirt Size*
GYLA Program I would like to attend:
- 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?*
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Applicant