Youth Leadership Institute (YLI) Youth Intake Form Youth's Name * First Name Last Name Youth's Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Youth's Age * 11 12 13 Youth's Gender * Male Female Prefer not to say Youth's Grade * 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade Parent/Guardian's Name * First Name Last Name Parent/Guardian's Home Phone Number * Parent/Guardian's Cell Phone Number * Parent/Guardian's Email Address * Relationship to Youth * Youth's Interests * Art Dance Photography Gardening/Nature Social Media Video Games Coding Entrepreneurship Music Social Justice Video/Filmmaking Community Service Financial Literacy Public Speaking Sports Writing Thank you for you for registering! We look forward to meeting you at an upcoming session.
