Allen Lima Leadership - Developing Tomorrow's Leaders Today!

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Personal Data

Name:	,		.	/ /
	Last	First	Middle Initial	Date of Birth

Home Address
Home Phone	( ) -
E-Mail Address
Gender	Female Male
Ethnicity

Do you have any family members who are graduates of Allen/Lima Leadership?
Yes No

High School attended:

Grade:

Cummulative GPA:

Please list school activities and the offices held in those activites:

General Information

A. List in order of significance, three major problems facing youth in the Lima/Allen County area today.

1.
2.
3.

B. What specific recommendations would you make to address the problem you listed in A-1 (above)?

C. Why do you think you should be selected to participate in Allen/Lima Youth Leadership?

D. What do you hope to gain from your participation in Allen/Lima Youth Leadership?

E. What community organizations or service groups do you participate in as a volunteer?

Special Honors and Awards

List any special honors or awards you have received.

Commitment Statement

I understand the goals and commitments of the Allen/Lima Youth Leadership program. If selected, I am willing to attend all the sessions/functions sponsored by Allen/Lima Youth Leadership and devote the necessary time to be a contributing member of the Allen/Lima Youth Leadership class. I understand that if I fail to meet these obligations I will be asked to withdraw from the program.

I agree to the above statement.

Any questions, please send an e-mail to all@wcoil.com.