Gwinnett Student Leadership Team

2017-2019

2017-2019Gwinnett Student Leadership Team

Application Check List

Please return all application materials to the Counseling Office

by Monday,September 19, 2016 (3:15 p.m.):

(1)Student Application including

  • Student information
  • Completed writings (I, II, III, and IV)
  • Signatures of student and parents
  • *Signature of principal (not required for initial application)

(2)GSLT Standards Form including

  • Signatures of student and parent(s) for

Statement of Commitment

(3)GSLT Parent Consent/Release Form including

  • Signatures of student, parent(s), and notary public

(4) Youth Registration Form

  • List of allergies, special dietary needs, and insurance information

(5) Recent Student Picture

  • Pictureof student (individual picture)

2017-2019 Gwinnett Student Leadership Team Application

Must be returned to the Counseling Office by Monday, September 19 at 3:15 p.m. Applications must be typed.

Student:

Name:______

Address:______

(Street Address)

______

(City) (Zip Code)

Home Phone:______Cell Phone: ______

E-mail Address: ______

School:______

Parent or Guardian:

Name:______

Address:______

(Street Address)

______

(City) (Zip Code)

Telephone:(Residence/Cell)______(Business)______

E-mail Address:______

Student Information:

I. LIST schoolAND community activities in which you are involved. Please include leadership positions. (Response should be a list only.)

II. Briefly describe yourself in a short paragraph. (Response limited to one paragraph.)

III. Please identify a student leadership initiative you want to implement in your school and provide an Action Plan for implementation. Explain why your school needs this initiative as well as outline steps to ensure its sustainability. Please note there are four components to this prompt: (A) Leadership Initiative; (B) Action Plan; (C) Need for the initiative; and (D) Steps for sustainability. Responselimited to one page.

IV. Provide one teacher recommendation focused on your communication and leadership skills.

As an applicant for the Gwinnett Student Leadership Team, I understand my selection encompasses a commitment on my behalf to attend all student leadership activities and events. If selected, I understand I am a representative of Gwinnett County Public Schools and the Gwinnett Community. I will conduct myself in an appropriate manner and represent the high standards of my school, my school district, and the Gwinnett Student Leadership Team.

______

Student's Signature DateParent's Signature Date

______

Parent's Signature DatePrincipal's Signature Date

2017-2019Gwinnett Student Leadership Team Standards

As a member of the Gwinnett Student Leadership Team, I agree to abide by the following standards:

  • Devote time and energy to developing my leadership skills as well as the skills of other students in my school;
  • Implement and facilitate leadership knowledge acquired through GSLT sessions in my high school;
  • Engage actively and positively in GSLT activities, showing respect for the input, feelings, and ideas of others;
  • Communicate actively with teachers, school administrators, GSLT members, and GSLT Board of Directors;
  • Adhere to the dress code for scheduled activities;
  • Remain alcohol and drug free throughout participation in GSLT;
  • Engage appropriatelyas a leader in the use of social media forums;
  • Design, plan, and execute a Senior Legacy Initiative (SLI). Each local school GSLT team will use the skills and knowledge acquired during the sophomore and junior years to create an initiative that will have an impact on their schools and, ultimately, leave a leadership legacy. Each SLI will be conducted under the guidance of the local school’s administrators including the principal, assistant principal, and other adult leaders. Implementation, completion, and documentation of this initiative are requirements for graduation from GSLT; and
  • Attend all scheduled GSLT activities outlined on the GSLT Instructional Calendar (two unexcused absences will result in dismissal) below. Some dates have not been selected yet, but the applicable months and years are listed below.

GSLT Instructional Calendar for the Class of 2017-2019

Sophomore Year

EVENT / DATE / LOCATION/TIME
Orientation / Tuesday, January 17, 2017 / The 1818 Club – 4:00-5:30 p.m.
Monthly Leadership Session / Monday, February 13, 2017 / Gwinnett Chamber - 7:15-11:30 a.m.
Monthly Leadership Session / Monday, March 6, 2017 / Gwinnett Chamber - 7:15-11:30 a.m.
GSLT Leadership Summit MANDATORY / Thursday, June 1, 2017 / Peachtree Ridge High School
8:00 a.m.-4:00 p.m.

Junior Year

EVENT / DATE / LOCATION/TIME
GSLT Retreat
MANDATORY / Friday, July 28, 2017
Saturday, July 29, 2017 / Location TBA
Friday: 8:00 a.m. - 8:00 p.m.
Saturday: 7:30 a.m. - 3:30 p.m.
Monthly Leadership Session / September 2017 / Gwinnett Chamber - 7:15-11:30 a.m.
Monthly Leadership Session
Networking Luncheon / October 2017 / Gwinnett Chamber - 7:15 a.m.-1:30 p.m.
Monthly Leadership Session / November 2017 / Gwinnett Chamber - 7:15-11:30 a.m.
Monthly Leadership Session / January 2018 / Gwinnett Chamber - 7:15-11:30 a.m.
Monthly Leadership Session / February 2018 / Gwinnett Chamber - 7:15-11:30 a.m.
Monthly Leadership Session / March 2018 / Gwinnett Chamber - 7:15-11:30 a.m.
Monthly Leadership Session / April 2018 / Gwinnett Chamber - 7:15-11:30 a.m.
GSLT Graduation for Seniors
GSLT Celebration for Juniors / April 2018 / Sunday Afternoon - 2:00-4:00 p.m.
Instructional Support Center
GSLT Leadership Summit MANDATORY / May/June 2018 – One week
following close of school / Peachtree Ridge High School
7:00 a.m.-4:00 p.m.

Senior Year

EVENT / DATE / LOCATION/TIME
GSLT Retreat
MANDATORY / Friday-Saturday in July or August of 2018 / Location TBA
Friday: 8:00 a.m. - 8:00 p.m.
Saturday: 7:30 a.m. - 3:30 p.m.
Monthly Leadership Session / September 2018 / Gwinnett Chamber - 7:15-11:30 a.m.
Networking Luncheon / October 2018 / Gwinnett Chamber - 11:30 a.m.-1:30 p.m.
Monthly Leadership Session / November 2018 / Gwinnett Chamber - 7:15-11:30 a.m.
Monthly Leadership Session / January 2019 / Gwinnett Chamber - 7:15-11:30 a.m.
Monthly Leadership Session / March 2019 / Gwinnett Chamber - 7:15-11:30 a.m.
GSLT Graduation for Seniors
GSLT Celebration for Juniors / April 2019 / Sunday Afternoon - 2:00-4:00 p.m.
Instructional Support Center
GSLT Leadership Summit MANDATORY / May/June 2019 - One week
following close of school / Peachtree Ridge High School
8:00 a.m.-4:00 p.m.

Statement of Commitment to Standards:

To maintain the integrity of the Gwinnett Student Leadership Team, I accept the challenges and responsibilities of being a leader and a role model in all aspects of life. I will show respect for myself, my peers, my school, my community leaders, the environments in which we meet, and GSLT. I agree to participate fully for two and a half years; attend all scheduled activitiesoutlined on the GSLT Instructional Calendar; follow all rules and regulations; and apply my knowledge and skills to benefit my school and my community. I will fulfill my responsibilities not only to the countywide GSLT initiative but also to my local school’s student leadership team. Furthermore, I understand that failure to uphold the standards outlined for GSLT students will result in my dismissal from the organization.

______

Signature of StudentDate

As parents of a GSLT student, we understand the responsibilities our son/daughter has accepted for the next two and a half years. We fully support his/her participation in the organization and attendance at all events.

______

Signature of Parent/GuardianDate

______

Signature of Parent/GuardianDate

2017-2019 Gwinnett Student Leadership Team

Parent Consent/Release Form

Release Waiver and Indemnification

The undersigned and his/her parent or legal guardian, if the participant is under the age of eighteen years, do hereby execute this release, waiver, and indemnification for him/herself, and his/her heirs, successors, representatives and assigns, and hereby agree and represent as follows:

To release the Gwinnett Student Leadership Team (GSLT), and the GSLT Board of Directors and Gwinnett County Public Schools, their officers, employees, and agents from any and all liability, loss, damage, costs, claims, or courses of action including, but not limited to, all bodily injuries and property damages arising out of the sole negligence of Gwinnett Student Leadership Team.

The undersigned further agree to indemnify and hold harmless the said above from any and all liability, loss, damage, costs, claims, or causes of action, including attorney fees and witness costs, arising out of the undersigned's participation in the Gwinnett Student Leadership Team.

The undersigned further give permission for the participant to take part in functions and trips and to be photographed during the two-year program for use in promotional purposes.

______

Signature of StudentDate

______

Signature of Parent/GuardianDate

Agreement and Consent for Treatment

This is to certify that I, the undersigned parent or guardian, hereby consent to and authorize the administration and performance of all needed medicines, surgical treatment, and the administration of any anesthetic which, in the opinion of the attending physician, may be necessary and advisable in the event of any medical emergencies regarding my son or daughter. I understand that efforts shall be made to contact the undersigned prior to rendering emergency treatment to the patient.

______

Signature of Parent/GuardianDate

______

Home PhoneWork Phone

______

Signature of NotaryDate

2017-2019 Gwinnett Student Leadership Team

Student Registration Form

School ______

Name ______Male_____ Female_____

Home Address ______

______

Phone ______Date of Birth ______

List Allergies (especially medications):

______

______

______

List Special Dietary Needs (including food allergies):

______

______

______

Health and Accident Insurance Provider ______

Group Number ______Policy Number ______

2017GSLT Sophomore Calendar

Tuesday, January 17, 2017 - 4:00-5:30 p.m.

Reception for New Students and Parents

Gwinnett Chamber of Commerce

The 1818 Club (located on the third floor of the Gwinnett Chamber)

Monday, February 13, 2017 - 7:30-11:30 a.m.

Leadership Development

Gwinnett Chamber of Commerce

Monday, March 6, 2017 - 7:30-11:30 a.m.

Leadership Development

Gwinnett Chamber of Commerce

Thursday, June 1, 2017 - 8:00 a.m.-4:00 p.m.

Student Leadership Summit

Peachtree Ridge High School

Friday, July 28 - Saturday, July 29, 2017

Leadership Retreat (location TBA)

Friday, July 28: 8:00 a.m. - 8:00 p.m.

Saturday, July 29: 7:30 a.m. - 4:00 p.m.