Student Leader Cohort Interest Form

Thank you for your interest in the new Student Leader Cohort. It is a leadership-development experience that trains, equips, inspires and walks alongside high schoolers within the Baltimore-Washington Conference to grow in leadership and world-transforming discipleship. Read more about the cohort here.

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1. Your Contact Information (Required.)

Name *

Home Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Mobile Phone Number *

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2. Your Birthday (Required.)

Date (MM/DD/YYYY)

Date

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3. We value diversity in all its dimensions. Please share the following about yourself as you are able. (Required.)

Gender (also for rooming purposes):

Race/Ethnicity:

Size of Your Church's Youth Group:

Context (rural, suburban, urban, etc.)

Expected Year of High School Graduation:

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4. Please provide the following information (Required.)

Parent(s)/Guardian(s) Name:

Parent(s)/Guardian(s) Email:

Parent(s)/Guardian(s) Phone:

Home Church:

District:

Church Address:

Pastor's Name:

Pastor's Phone:

Pastor's Email:

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5. Which focus area are you most interested in being a part of (check all that apply) (Required.)

BWC Annual Conference Sessions

Compassionate Justice

Mental Health

Project at Your Local Church or District

YPM Communications

Other (please specify)

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6. The following is a list of Student Leader development opportunities. Let us know in which one(s) you are committed to participate. (Required.)

	No	Maybe	Yes
Student Leader Cohort Orientation Retreat on January 10-12	Student Leader Cohort Orientation Retreat on January 10-12 No	Student Leader Cohort Orientation Retreat on January 10-12 Maybe	Student Leader Cohort Orientation Retreat on January 10-12 Yes
Connect Leadership Summit (Student Leader Track) on March 7	Connect Leadership Summit (Student Leader Track) on March 7 No	Connect Leadership Summit (Student Leader Track) on March 7 Maybe	Connect Leadership Summit (Student Leader Track) on March 7 Yes
Connect Leadership Summit (Student Leader Track) on March 14	Connect Leadership Summit (Student Leader Track) on March 14 No	Connect Leadership Summit (Student Leader Track) on March 14 Maybe	Connect Leadership Summit (Student Leader Track) on March 14 Yes
Annual Conference Session on May 29-31	Annual Conference Session on May 29-31 No	Annual Conference Session on May 29-31 Maybe	Annual Conference Session on May 29-31 Yes
Leadership, Discipleship, Relationship Camp on June 17-26	Leadership, Discipleship, Relationship Camp on June 17-26 No	Leadership, Discipleship, Relationship Camp on June 17-26 Maybe	Leadership, Discipleship, Relationship Camp on June 17-26 Yes
MissionU Youth Retreat on July 24-26	MissionU Youth Retreat on July 24-26 No	MissionU Youth Retreat on July 24-26 Maybe	MissionU Youth Retreat on July 24-26 Yes
LeadHer Camp on July 26-31	LeadHer Camp on July 26-31 No	LeadHer Camp on July 26-31 Maybe	LeadHer Camp on July 26-31 Yes
United to Love Action in DC on September 19	United to Love Action in DC on September 19 No	United to Love Action in DC on September 19 Maybe	United to Love Action in DC on September 19 Yes

Student Leader Cohort Interest Form

Question Title

* 1. Your Contact Information (Required.)

Question Title

* 2. Your Birthday (Required.)

Question Title

* 3. We value diversity in all its dimensions. Please share the following about yourself as you are able. (Required.)

Question Title

* 4. Please provide the following information (Required.)

Question Title

* 5. Which focus area are you most interested in being a part of (check all that apply) (Required.)

Question Title

* 6. The following is a list of Student Leader development opportunities. Let us know in which one(s) you are committed to participate. (Required.)

Question Title

* 7. Tell us why you want to be part of this Student Leader Cohort:

1. Your Contact Information (Required.)

2. Your Birthday (Required.)

3. We value diversity in all its dimensions. Please share the following about yourself as you are able. (Required.)

4. Please provide the following information (Required.)

5. Which focus area are you most interested in being a part of (check all that apply) (Required.)

6. The following is a list of Student Leader development opportunities. Let us know in which one(s) you are committed to participate. (Required.)

7. Tell us why you want to be part of this Student Leader Cohort: