Junior Leadership of Laramie County

Junior Leadership of Laramie County September 2013 – June 2014 (Confidential Application) Registration: $75 Due June 30, 2013

NOTE: ONLY STUDENTS IN THEIR JUNIOR YEAR 2013/2014 ARE ELIGIBLE

Personal Data

Name: ______Nickname or Preferred Name: ______Date of Birth: ______Email Address: ______Home & Cell Number: ______Home Address (include City & Zip Code): ______Mailing Address (if different than above): ______How long have you lived in Laramie County: _____ (years) which high school do you attend? ______What are your plans after high school graduation, and what has influenced them? ______Activity Data List your volunteer experiences (with dates): ______List your activities and interests: ______List awards or recognition you’ve received: ______List your work experience: ______More about You Tell us about one of your unique and special qualities, and relate an experience you’ve had to that quality. ______

Your Interest in Junior Leadership How did you hear about Junior Leadership of Laramie County? ______

How would you benefit from participating in junior leadership? ______How would you contribute to the junior leadership program? ______What do you view as the most pressing issues for youth in Laramie County? ______List three positive aspects of living in Laramie County, and how they have influenced you. ______

Applicant’s Personal Reference (must be an adult): Name: ______Phone Number: ______Relationship to Applicant: ______

Write an essay (limited to 500 words) with your definition of leadership and how it applies to today’s youth. Please attach it to your application.

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Attendance is critical to the program’s overall outcome and objectives. If selected, you are obligated to make a commitment to attend the majority of the programs (no more than one absence). Your signature below indicates your understanding of this commitment and acceptance of the program’s requirements. Applicant’s Signature: ______Date: ______

Parent/Legal Guardian Name: ______Phone: ______Address: ______

I have read, understand and support the requirements of this program, including the importance of attendance, and will ensure compliance and provide transportation for attendance at the Junior Leadership program locations each month. Further, I give my permission for ______to have six excused absences from school (one full school day per month from September 2012 to June 2013) for participation in Junior Leadership.

Parent/Legal Guardian’s Signature: ______Date: ______

In case of an emergency, whom do we contact? Name: ______Phone Number: ______Relationship to student: ______

Send completed application & essay to: Junior Leadership of Laramie County • P.O. Box 1503 • Cheyenne, WY 82003