Program Application

Eligibility and Selection Criteria

Program Application Form

First Name

Middle Name

Last Name

Suffix

Email Address

Date of Birth

Phone Number

Address 1

Address 2

City

State

Zip

What is your ethnicity (optional)

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Relationship to Applicant (please select)

Parent/Guardian Phone Number

Parent/Guardian Email Address

Are you currently a graduating high school senior in the 2024-2025 academic school year?

Do you have an unweighted academic average GPA or 2.0 or higher?

Have you been accepted into a technical/vocational, college, or university for the Fall 2025 semester?

What technical/vocational, college, or university will you attend (please include school name, city, and state)?

Please share your major or intended field of study.

Please select the activities you have participated in:

School Activities (clubs, school sports, student government, fine arts, other honors/awards, etc.) Community and Personal Activities (volunteer work, church, youth programs, athletic programs, music, dance, scouts, 4H, etc.) Work Experience (includes self employment and employment during the school year and summer months) Organization Leadership Positions (student government, club president/vice president/secretary/treasurer, youth camp leader, etc.)

Essay (500 words or less): Reflect on someone or something that has inspired you to be a community leader. How has this motivated you to pursue your major and/or course of study? How do you plan to use your experience to be of service to your local community?