North Shore Youth Leadership (NSYL)

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2022 Application Servant Leadership Essentials for Youth

Email *

Applicant First Name *

Applicant Last Name *

Applicant Street Address *

Applicant City *

Applicant State *

Applicant ZIP *

Applicant Mobile #

Applicant Email Address *

Parent/Guardian First Name *

Parent/Guardian Last Name *

Parent/Guardian Street Address (if different)

Parent/Guardian City

Parent/Guardian State

Parent/Guardian Postal Code

Parent/Guardian Mobile # *

Parent/Guardian Email Address *

Applicant High School *

Areas of Interest (Studies) *

Areas of Interest (Career) *

Extracurricular Activities (# of years/dates active) *

Why is it important you be selected for NS Youth Leadership 2022? *

Do you believe that your future depends on what you know or who you know? Why? *

What is your definition of leadership? How do you apply this definition of leadership in your own life? *

Scholarship: I would you like to be considered for a scholarship?

Yes

Clear selection

A limited amount of scholarship funding is available. Please explain your need for a scholarship and how much you could contribute toward the program cost?

Zero-Tolerance Policy* The North Shore Youth Leadership (NSYL) Program is committed to providing a safe learning experience for its participants and adheres to a zero-tolerance policy for substance abuse. Should a school official, law enforcement agency or NSYL Program authority suspect a NSYL participant of illegal or illicit drug use, possession, or association, he/she will be subject to disciplinary action. This action may include a meeting with the participant, parents, and school officials. Dismissal from the NSYL Program may occur. Any behavior that leads to the possibility of a citation for underage drinking, driving under the influence and other alcohol-related offenses may result in dismissal from the NSYL Program. Any behavior that leads to a student being expelled from school will result in dismissal from the program. I, the NSYL Applicant, acknowledge that I have received and read the above drug, alcohol, and expulsion policy and that I agree to abide by its terms. I acknowledge that it is my responsibility to inform the NSYL Coordinator should any of the above situations occur. *

Check here to indicate that you have read and agree to the zero-tolerance policy.

Required

We, the NSYL Applicant and Parent(s)/Guardian(s), understand that it is the responsibility of the NSYL participant to arrange for transportation to and from all NSYL events and that Sophia Transformative Leadership Partners will not fulfill this function or take any responsibility for it. *

Check here to indicate that you have read and agree to the transportation requirements for this program.

Required

Injury Statement* We, NSYL Applicant and Parent(s)/Guardian(s), understand that the NSYL participant will be financially responsible for any and all expenses incurred due to injuries sustained traveling between school and the program site. *

Check here to indicate you have read and agree to accept this injury statement.

Required

Release from Liability* We, the NSYL Applicant and Parent(s)/Guardian(s), agree to hold NSYL harmless and waive our right to file a claim, pursue legal action or seek financial reimbursement from Sophia Transformative Leadership Partners, NSYL, its board members, employees or any volunteers associated with this program which aforementioned rights may arise out of participation in the program. *

Check here to indicate you have read and accept the release from liability statement.

Required

Photo Release* We, the NSYL Applicant and Parent(s)/Guardian(s), consent to the taking and/or use of photographs of myself/our child for promotional purposes by the NSYL Program. *

Check here to indicate that you have read and consent to the photo release statement.

Required

Policy and Waiver Consent* *

We, the NSYL Applicant and Parent(s)/Guardian(s), have read and understood all of the above policy statements and agree to adhere to said policies.

Required

Name *

Date *

YYYY

Send me a copy of my responses.

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