Youth Leadership Birmingham Application

Applications for Youth Leadership Birmingham 2024-2025 program year are due Friday, September 13, 2024 at 11:59 PM. Please review the program calendar and be sure the dates are clear before you submit an application. For more information on the entire application process, watch the applicant information video.

Today's Date*
Attendance Policy Confirmation*
- Yes, I understand the attendance policy and can commit to full participation in YLB if I were to be selected as a member of the YLB Class of 2025.
Please check the box above to confirm that you have made every effort to understand and prioritize the YLB program dates if you were to be selected as a participant.
Personal Information
Name*
First Middle Last
Preferred name (printed on nametags:)*
Have you submitted an application to YLB in the past?*
- Yes
- No
Gender*
Race*
Date of Birth*
Month
Day
Year
Current Grade*
- 10th Grade
- 11th Grade
School*
Student Phone*
Home Address*
Street Address Address Line 2 City State ZIP Code
Email Address*
Names of Parent(s)/Guardian*
Parent/Guardian Email:*
Parent/Guardian Phone*
School Experience
Other Schools Attended*
List up to three special awards, honors or recognitions for academic, school or community related activities you have received from the 7th through 10th grades:*
Main area of interest in studies:*
GPA*
GPA Scale*
Organizations & Activities
In order of importance to you, list up to five school, volunteer, religious, social, athletic, or other activities or organizations in which you have participated during the last four years.*
Organization / Activity Grade in School Leadership Responsibility / Involvement
Work Experience
List any job experience, paid or volunteer, and briefly tell what it involved:
Do you currently have a part-time job?*
- Yes
- No
If you have a part-time job, how many hours do you work per week?
General Information
1. Using a few phrases or adjectives, describe yourself:*
2. What three issues concern you most about Birmingham?*
3. Which session listed on the program calendar interests you most? What do you expect to get out of YLB?*
4. What else would you like to tell us about yourself?*
Essay
Please respond to the following question in 250 words or less. If you could change anything in your community, what would it be, why, and how would you make the change?*
List the names and emails of your references. IMPORTANT: You will need to send them a link to the online reference form to complete. https://leadershipbirmingham.org/youth/references/*

Organization / Activity	Grade in School	Leadership Responsibility / Involvement

Youth Leadership Birmingham Application

Personal Information

School Experience

Organizations & Activities

Work Experience

General Information

Essay