* 1. Student's Contact Information

* 2. Do you get texts?

* 7. Parent's Contact Information

* 8. I would like to be involved in Jennings County Youth Leadership because...

* 9. What do you expect to gain by being involved in Jennings County Youth Leadership?

* 10. What do you think is the biggest problem facing youth?

* 11. Have you ever attended any type of Leadership Training? If so, please explain.

* 12. Please list your extracurricular activities.

* 13. What are your future plans?

* 14. What does “Community” mean to you?

* 15. Participation in JCYL involves missing class one day a month and you must communicate with your parents, teachers, and make up assigned work. Other time commitments may include leaving before school starts, one trip returns around 6:30PM, occasional evening and weekend or summertime projects. How does this affect your schedule or other activities?

* 16. JCYL will provide monthly learning experiences, activities and trips off campus- you will miss class and be required to make up missed work & assignments. Are you willing to make this commitment to the JCYL Program?

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