The application must be completed by March 9, 2017. The Selection Committee will review only completed applications submitted by the deadline. There is no fee to apply. If selected, the program fee of $100 will be covered by scholarship. All applicants will be notified of selection in May 2017.

You must be a current high school sophomore residing in Pottawattamie County to apply for this program. Participation in the Youth Leadership Council Bluffs program occurs during your high school junior year.

* 1. Youth Leadership Applicant Information:

* 2. School Related Activities: List up to five school related activities in which you have participated during the last two years.

* 3. If you haven’t had the opportunity to participate in school activities/organizations, why not? (Check all that apply.)

* 4. Non-School/Non-Work Activities: List up to five non-school related or non-employment related activities in which you have participated during the last two years. (For example: community, civic, religious, scouting, volunteer, athletics, etc.).

* 5. If you haven’t had the opportunity to participate in non-school activities/organizations, why not?

* 6. List any special recognition or honors for academic, religious, sports, or community related activities have received or the last two years. If you have not received any recognition or honors, please indicate by "N/A".

* 7. If selected for the Youth Leadership Council Bluffs program, how would you balance your extracurricular activities with your commitment to the program?

* 8. Will you be employed during the 2017-2018 school year?

* 9. What career(s) do you have an interest in?  What about them interests you?

* 10. If you could spend a day with a current world leader, artist, or sports star, who would you choose and why?

* 11. Describe a special gift or talent you have.

* 12. How can you be a role model for younger children in your community?

* 13. Describe a time when your actions positively affected a person, your school, or your neighborhood.

* 14. If you could change anything about your school, what would it be and why?

* 15. If you could change anything about your community, what would it be and why?

* 16. What is the likelihood that you will reside in Council Bluffs area after high school, college, etc.?

  Not Likely Somewhat Likely Very Likely Not Sure
Rank:

* 17. How did you find out about Youth Leadership Council Bluffs?

* 18. What else would you like to tell us about yourself?

* 19. Please provide two adults references. Someone who knows you well, excluding parent, guardian, or relative (example: teacher, employer, faith leader, etc.).

* 20. Parent(s)/Legal Guardian

* 21. School Principal

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