Youth Leadership Application

2008

You may use this convenient on-line form to submit your Youth Leadership Application. Simply fill in each of the items on the application and click the submit button at the bottom of the form. We will acknowledge receipt of you application within 48 hours. You must also submit by mail or fax a signed copy of the Parent/Guardian Permission form. All first time applicants must also submit one reference letter.

I. Personal Information

Name: 
Nickname:
Home Address 1:
Home Address 2:
City: State: Zip:
Home Phone:

E-mail Address:

Date of birth: Age:

School:

Present Class: Freshman Sophomore Junior             

In what other activities are you currently involved? (athletics, clubs, churches, etc.) Please list and briefly describe if necessary.

Are you currently working? Yes No

If yes, where do you work? 

# of hours per week:
Responsibilities:

Describe any past work-related experiences.

Youth Leadership meets monthly starting in April. The meetings are held at Valley United Way, 3 Corporate Drive, Suite 501, Shelton from 5:00 – 6:30 p.m.

Are you able to attend meetings on this day and time throughout the 2008 year?
Yes  No

Would you have transportation to the meetings? Valley United Way is unable to provide transportation for meetings. 

Yes  No

Youth Leadership members attend a weekend “Teambuilding Retreat” at Camp Jewell in Colebrook, Connecticut in April.  Valley United Way will provide transportation for the retreat.

Are there any circumstances that will prevent you from attending?

Yes  No

If yes, please describe:

You will receive confirmation of your application by e-mail within 48 hours.

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