Youth Deal of Mayfield/Graves County

YOUTH LEADERSHIP

SPONSORED BY:

Youth Deal of Mayfield/Graves County

Mayfield/Graves CountyChamber of Commerce

GravesCounty Board of Education

Mayfield Independent Board of Education

GravesCountyHigh SchoolSUMMITYSC

MayfieldS.T.A.R.YouthServicesCenter

Ronald McDonald House Charities

APPLICATION PACKET

COMPLETE AND RETURN TO Mrs. Horn IN THE YOUTHSERVICESCENTER NO LATER THAN

May 29, 2015

Student Name:

Please type this application.

A downloadable version of this application is on the GCHS website

just under the “High School News” heading.

MAYFIELD/GRAVES COUNTY

YOUTH LEADERSHIP APPLICATION

Return to Mrs. Horn in the YouthServicesCenter no later than

May 29, 2015

PERSONAL INFORMATION

(Please type)

Name:

(Last)(First)(Middle)

Name Preference:Phone:

(Nickname)

Date of Birth:Place of Birth:

(Day/Mo./Yr.)(City & State)

Street Address:

City:State:Zip Code:

Parent/Guardian Name:

Parent/Guardian Name:

Emergency Contact:Phone:

The Youth Leadership Program is a collaborative effort with our community partners donating their time and expertise. As a result, the Youth Leadership Program MUST BE A PRIORITY in your schedule. While we try to coordinate schedules as much as possible, a conflict may occur and it is up to you to resolve any scheduling conflicts. If selected, your signature below is a commitment to attend each of the program sessions including the opening retreat and the graduation ceremony/dinner.

YES (initial on line)

Signature of Applicant:Date:

Parent/Guardian Signature:Date:

Please complete the following questions/statements:

1. Describe yourself.

2. What three things concern you the most about life in Mayfield and GravesCounty (list according to importance)?

3. Which session in the program calendar interests you the most and what do you expect to learn from that session? (Arts & Humanities; Government; Environment; Health; Agriculture; Business & Industry; Community Resources)

4. If you could change anything about our community, what would it be? How would you make the change?

5. What work experience, paid or volunteer, do you have? Briefly explain your responsibilities.

Do you currently have a job? How many hours per week?

Would your job interfere with your attendance at Youth Leadership?

6. Who has been the most influential person in your life? Why?

7. How would you describe a leader? What qualities must a leader possess and why?

8. List in order of importance three (3) organizations, clubs, teams or groups of which you have been a part during your high school career. Comment briefly on why your participation was important to you.

MOST IMPORTANT:

SECOND MOST IMPORTANT:

THIRD MOST IMPORTANT:

I am completing this application with the understanding that if I am selected, I will serve my community and set an upstanding example for my peers. If I violate this understanding, my enrollment will be compromised and status will be determined by a group of my peers. In order to complete

The program I will be expected to give of my time and talent as needed. I also understand that I will be required to participate in all scheduled days, trips, events and meetings unless otherwise approved. I will be a supportive member of my leadership team and maintain a positive attitude at all times.

SignatureDate