Washington County Teen Leadership Application

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Washington County Extension Office
245 Corporate Drive, Springfield KY 40069
Phone Number 859-336-7741
Email- Melissa.Schenck@uky.edu

Washington Co. Schools
120 Mackville Hill Rd.
Springfield, KY 40069
Email- allison.carney@washington.kyschools.us

Please complete and submit online OR obtain a paper copy from the WCHS Office. ALL APPLICATIONS DUE FRIDAY, MAY 10th, 2024

First and Last Name *

T-Shirt Size *

XXL

Other:

Mailing Address *

Male or Female *

Female

Male

Student Phone Number *

Is adding student to REMIND okay? *

Yes

Parents/Guardians/ Names *

Parent Phone Number *

Student Agreement- If selected, I will make a commitment to attend ALL Teen Leadership Washington County Program Sessions. And I understand that I may have to provide my own transportation to some meetings or events. *

Yes

Parent Agreement- If student is selected, you will make a commitment to help your child attend ALL Teen Leadership Washington County Program Sessions and I understand that my child or I may have to provide our own transportation to some meetings or events. *

Yes

Please List any known Allergies/Food Allergies *

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