2017NCCEP/GEARUPYOUTHSUMMIT

July16-19,2017

HiltonSanFrancisco UnionSquare

SanFrancisco,California

APPLICATIONFORMS

Thefollowingitemsarerequiredforeachstudent

A.StudentInformation/KeyContactInformationForm

B. YouthCongressApplicant:StudentStatement

C.GEARUPDirectorForm(signed)

D.Parent/GuardianConsentFormandContactInformation

(signed)

E.PermissionReleaseFormforVideotapingSessionsand

TakingParticipantPhotos(signed)

F.ChaperoneAgreementForm(signed)

G.YouthCongressStudentAgreementForm(signed)

  1. StudentInformationIKeyContactInformation

*AllinformationonthispageisrequiredandmustbeTYPEDinbold.

StudentInformation

•Studentname(first,middle,lastname):

•Male/Female:

•AgestudentwillbeasofJuly16,2017:

•Student'sbirthday(month,day,year):

•GradestudentwillbeinasofSeptember1,2017(2017-2018) schoolyear:

•Student'sschool(2017-2018schoolyear):name,website,andmailingaddress:

•Student'shomeaddress,city,state,zipcode:

•Student'se-mail(NCCEPwillnotcontactthestudentwithoutnotifyingtheGEARUPdirector):

•Student'sT-shirtsize(small,medium,large,orXL)

•Noteanyallergiesormedicalconditions:

EmergencyContactInformation

•Student'sparentorguardianinformation:fullname,relationship,e-mail,homephonenumber,and cellphonenumber:

  • Willthispersonbeattendingthe2017NCCEP/GEARUPAnnualConference? Y//N

•ListatleastoneleadYouthCongresschaperonedesignatedbyyourgrantwhowillbeattendingthe2017 NCCEP/GEARUP AnnualConference:name,title,email,andcell phonenumber:

•AdditionalkeycontactonyourGEARUPprogramstaffwhowillbeattendingthe2017annual conference:name,title,e-mail,workphonenumber,andcellphonenumber:

  1. YouthCongressApplicantStudentPersonalStatement

Thankyouforapplyingtothe2017NCCEP/GEARUPYouthCongress!TheYouthCongressisan interactivelearningexperiencethatcallsfortheactiveparticipationofallstudents.

PleasemakesuretoTYPEyouranswers(required)below.YourGEARUPdirectorwillsubmitthe

PersonalStatementyouwritebelowasaWorddocumenttoNCCEP.

Pleasesaveacopyofyouranswers,below.Youmaywanttousesomeofthisinformationagainwhen youinteractwithotherYouthCongressstudentsonlinepriortotheNCCEP/GEARUPconference.

PracticeTellingYour GEARUPStory

Before,during,andaftertheYouthCongressyouwillhaveopportunitiestopracticetellingyour"GEAR UP"story.OneoftheoutcomesoftheYouthCongresswillbeforyoutohavetheopportunityto shareyourstoryonNCCEP'swebsiteineitherashort(maximumthreeminutes)videoorinwritten format(maximum900words).

Inthespacebelow,pleaseintroduceyourselfandshare abitofyour"GEARUP"story.Inthiscase, pleasewriteyouranswersinashort,personalized, interestingstoryformat(asifitisthescriptforyour video).Yourstoryshouldbeamaximumof900words{pleasedoawordcount).Pleaseproof-readand copyedityourstorybeforesubmittingit.

InyourGEARUPstory,makesuretoincludethefollowing:

•Introduceyourself:yourname,grade,school,andwhereyoulive(thecity,state,regionthatyou live),includingmentioningsomethinginterestingoruniqueaboutyourschoolorcommunity

•Whatyouliketostudyandwhy

•Whatyouthinkyoumightwanttodointhefutureintermsofajob/career(ifyouare notsure youcanmentionacareerareathatinterestsyouthatyouwanttolearnmoreabout)

•Whatyouappreciate abouttheGEAR UPprogram/howinvolvementinGEARUPhasbenefited you(beasspecificasyoucan giveoneormoreexamplesthatareimportanttoyou)

Pleasealsoincludethefollowing:

•Somethinginterestingaboutyourself! Mentiononeormoreofyourinterestsortalents...

•Mentionachallengeyouhavefaced(orface)and/oranaccomplishment youareproudof

•Mentionyouridealcollegeoruniversity(Whatdoesagood"collegefit''looklikeforyou?)

•Mentionadreamyouhaveaboutmakingyourcommunity,state,country,or theworldabetter place(forexample,mentionanIssueyouareconcernedaboutandanideayouhavetohelp addresstheproblem)