Youth Action 2021-2022 Service Leader Program Application

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Youth Action’s Service Leader Program (SLP) works with upperclass high school students who are alumni of the Junior Youth Action (JYA) and Inspiring Leaders (ILP) programs and provides students with volunteer opportunities as well as advanced leadership workshops around socially responsible leadership in college & career.

The SLP Program meets twice a month from September through May at the University of the Sciences from 10am - 1:30pm.

If you are interested, please complete the application below. If you have any additional questions, please contact inspire@youthactionteam.org or call 1-888-YOUTH90 ext 906.

Applicant Information

Please fill in the following fields with the Student Applicant's information.

First Name *

Last Name *

Address *

Street Address, City, State, & Zip Code

Date of Birth *

YYYY

Phone Number *

Please enter using this format: (XXX) XXX-XXXX

Email Address *

Please verify that your email address is typed correctly.

School *

Grade Level for Fall *

Your Passion/Career Interest *

Parent/Guardian Information

Please fill in the following fields with Parent/Guardian information.

Parent/Guardian First Name *

Parent/Guardian Last Name *

Parent/Guardian Email Address *

Please verify that the email address is typed correctly.

Parent/Guardian Phone Number *

Please enter using this format: (XXX) XXX-XXXX

Relationship to Student *

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