Youth Leadership Council Bluffs - 2023 Application The application must be completed by March 26, 2023. The Selection Committee will review only completed applications submitted by the deadline. There is no fee to apply or participate. All applicants will be notified of selection by August 2023.You must be a current high school sophomore residing in or attending school in Pottawattamie County to apply for this program. Participation in the Youth Leadership Council Bluffs program occurs during your high school junior year. Question Title * 1. Youth Leadership Applicant Information: Student Name (First & Last Name): Home Address: City, State Zip: School: Current Grade Level: Birth date: Phone: Email: Question Title * 2. School Related Activities: List up to five school related activities in which you have participated during the last two years. Name of Club/Organization: - Years Involved: - Your Role: Name of Club/Organization: - Years Involved: - Your Role: Name of Club/Organization: - Years Involved: - Your Role: Name of Club/Organization: - Years Involved: - Your Role: Name of Club/Organization: - Years Involved: - Your Role: Question Title * 3. If you haven’t had the opportunity to participate in school activities/organizations, why not? (Check all that apply.) I do participate in school activities/organizations. Time Not interested Transportation Financial reasons Work Other (please specify) Question Title * 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.). Name of Club/Organization: - Years Involved: - Your Role: Name of Club/Organization: - Years Involved: - Your Role: Name of Club/Organization: - Years Involved: - Your Role: Name of Club/Organization: - Years Involved: - Your Role: Name of Club/Organization: - Years Involved: - Your Role: Question Title * 5. If you haven’t had the opportunity to participate in non-school activities/organizations, why not? I do participate in non-school activities/organizations. Time Not interested Transportation Financial reasons Work Other (please specify) Question Title * 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". Question Title * 7. If selected for the Youth Leadership Council Bluffs program, how would you balance your extracurricular activities with your commitment to the program? Question Title * 8. What career(s) do you have an interest in? What about them interests you? Question Title * 9. If you could spend a day with a current world leader, artist, or sports star, who would you choose and why? Question Title * 10. What does diversity, equity, and inclusion mean to you and why they are important? Question Title * 11. Describe a time when your actions positively impacted a person, your school, or your community. Question Title * 12. If you could change anything about your school, what would it be and why? Question Title * 13. If you could change anything about your community, what would it be and why? Question Title * 14. What is the likelihood that you will reside in Council Bluffs area after high school, college, etc.? 1 - Not Likely 2 - Somewhat Not Likely 3 - Unsure 4 - Somewhat Likely 5 - Very Likely Rank: Rank: 1 - Not Likely Rank: 2 - Somewhat Not Likely Rank: 3 - Unsure Rank: 4 - Somewhat Likely Rank: 5 - Very Likely Question Title * 15. How did you find out about Youth Leadership Council Bluffs? Friend Teacher Counselor Parent Chamber of Commerce Internet Other (please specify) Question Title * 16. What else would you like to tell us about yourself? Question Title * 17. Please provide two adults references. Someone who knows you well, excluding parent, guardian, or relative (example: teacher, employer, faith leader, etc.). Reference #1 Name: - Title/Position - Organization - Address: - Phone: Reference #2 Name: - Title/Position - Organization - Address: - Phone: Question Title * 18. Parent(s)/Legal Guardian Name: Address: Home Phone: Work Phone: Cell Phone: Email: Question Title * 19. School Principal Name: Work Phone: Email: Done