Question Title

* 1. What is your FIRST name?

Question Title

* 2. What is LAST name?

Question Title

* 3. What is your AGE?

Question Title

* 4. What is your HOME address?

Question Title

* 5. What is your EMAIL ADDRESS? (this email will be used for communicating purposes during the duration of the program)

Question Title

* 6. What is your CELL PHONE number? (this number will be used for communications purposes during the duration of the program)

Question Title

* 7. Please prove the NAME, PHONE NUMBER and EMAIL ADDRESS of your PARENT and or GAURDIAN.

Question Title

* 8. Please provide the NAME and PHONE NUMBER of the person we should call in the case of an EMERGENCY.

Question Title

* 9. What is you relationship with this person?

Question Title

* 10. What GRADE are you in?

Question Title

* 11. What MIDDLE or HIGH SCHOOL do you attend?

Question Title

* 12. How did you hear about the T.M.A.D program?

Question Title

* 13. Identify 2  leadership positions you have held. Include present and past volunteer, community or religious involvement with the name of organization(s), position(s) you have held, your responsibilities, duration and the name of your immediate supervisor (s).

Question Title

* 14. What is your definition of a leader? Why do you feel you would make a great leader in your community?
*Please type your essay, and send to ajerry@arlingtonva.us 

Word Requirements
(Middle School Students: min.150 max.500 words)
(High School Students: min.200 max.500 words)

Question Title

* 15. Please share why you should be chosen to participate in the T.M.A.D experience?
*Please type your essay, and send to ajerry@arlingtonva.us 

Word Requirements
(Middle School Students: min.150 max.500 words)
(High School Students: min.200 max.500 words)

Question Title

* 16. What do you hope to gain from your T.M.A.D experience?
*Please type your essay, and send to ajerry@arlingtonva.us 

Word Requirements
(Middle School Students: min.100 max.500 words)
(High School Students: min.100 max.500 words)

Question Title

* 17. FINAL REQURIEMENT: Please SUBMIT one (1) letter of recommendation from an academic advisor, mentor, or counselor. References cannot be from family members. Please include name, job title and or position, address; city, state and zip code, phone number and email if available.

Recommendation DUE: *date will be given at first TMAD meeting.

**Please return all forms to Desi Jerry at ajerry@arlingtonva.us
**For more information call: (703) 228-7781

T