2016-2017
Applicant's Name:Phone Number(s):
Address:
City: / Zip:
Parent’s Name(s):
High School:
DEADLINE: Wednesday, August 31, 2016
Return applications to sponsor(s) at your school who will then submit for class consideration:
Calhoun High School: Brandi Hayes, Christina Long, Rob Thompson
Georgia Cumberland Academy: Deborah Theus
Gordon Central High School: Renee Hughes, Alan Hughes, Carol Holland
Sonoraville High School: Ashley Brookshire
You will be notified by mail of your acceptance to the Gordon County Youth Leadership Program.
Below is a tentative schedule for the 2016-2017 class.
Make sure you can meet on all of these dates before submitting an application.
*Perfect attendance is required for eligibility for the $1000 scholarship awarded to one student from the class at the end of the program.
*You may only miss one session and be eligible for graduation - at the 2nd absence – you will be dropped from the class.
Please direct any questions you have to the person listed on the first page at your school.
GORDON COUNTY YOUTH LEADERSHIP
2016-2017 CLASS SCHEDULE
Activity / Location of Departure / Date / TimeOrientation/ Outdoor Adventure* / GA Cumberland Academy / Tuesday, September 27 / 11:30 pm – 3:00 pm
Government Day / Meet at National Guard Armory / Tuesday, October 25 / 7:15 am – 4:00 pm
Gordon County
Commission Meeting / Gordon County Courthouse / Tuesday, November 1 / 6:00 pm – 7:30 pm
County Tour Day
-Emergency/Health Services- / TBA / Tuesday, December 6 / 8:00 am – 3:30 pm
Calhoun City
Council Meeting / Calhoun Depot / Monday, December 12 / 6:00 pm – 8:00 pm
County Tour Day
-Business/Industry- / TBA / Wednesday, January 18 / 8:00 am – 3:30 pm
Arts and Culture / TBA / Thursday, February 9 / 6:00 pm – 8:00 pm
Community Resources / TBA / Wednesday, March 15 / 8:00 am – 2:00 pm
Graduation / TBA / Thursday, March 23 / 6:30 pm
*Wear comfortable clothing and shoes, may be muddy. You are responsible for transportation.
Please use the space provided to complete application.
Do not attach additional sheets.
CALHOUN-GORDON COUNTY
YOUTH LEADERSHIP PROGRAM APPLICATION
I. BASIC INFORMATION
Name:Last / First / Middle
Home Address:
City: / Zip:
Email Address: / Cell Number:
Do you have any special dietary requirements (vegetarian, allergies, etc) that the committee should be aware of when preparing meals for Youth Leadership events? / Yes: / No:
If Yes, please explain:
Senior: / Junior: / I applied last year and was not selected:
II. SCHOOL INVOLVEMENT
A. Please list any school activities in which you have been involved (clubs, athletic teams, etc.) Please indicate the role you played in the activity(ies). The more diverse the better.
Activity: / From: / To:Assignment/Position:
Personal Responsibilities:
Activity: / From: / To:
Assignment/Position:
Personal Responsibilities:
Activity: / From: / To:
Assignment/Position:
Personal Responsibilities:
B. Please list any offices held or recognition received from any organizations or groups with which you have been involved through school.
III. COMMUNITY INVOLVEMENT
Please list any civic, religious, social, athletic, or other activities in which you have participated. Indicate your role in the organization(s).
Organization: / From: / To:Assignment/Position:
Personal Responsibilities:
Organization: / From: / To:
Assignment/Position:
Personal Responsibilities:
Organization: / From: / To:
Assignment/Position:
Personal Responsibilities:
IV. EMPLOYMENT RECORD
Please list your employment history, beginning with the most recent position. If you require additional space, please consult with your school contact person. If you have not been employed, please go to the next section.
Employer: / Title/Position:Briefly Describe the Duties and Responsibilities of the Position:
V. PERSONAL ACHIEVEMENTS
What do you consider as your three most significant contributions or achievements in school, at home, or in your community?
1.2.
3.
VI. GOALS
Write a short paragraph (100 words or less) about what you hope to gain from your involvement in the Youth Leadership Program.