10th Annual
Wisconsin Youth Leadership Forum (YLF)
for High School Students with Disabilities

June 19-24th, 2011
Edgewood College, Madison, WI
APPLICATION FORM
Submission Deadline: April 1, 2011


Students must complete ALL information on this application.

Your last name is required.

Your first name is required.




Please make a selection.


Your birthdate is required.Please use format: mm/dd/yy.

We require your residence address.

Your city is required. Your state is required. Your ZIP is required.

Your phone number is required.Please use format: (608) 123-4567

Your email address is required.Please use format: you@mail.com




Please make a selection.


Your high school is required.

Your high school city is required. Your high school state is required. Your high school ZIP is required.Invalid format.

A phone number is required.Please use format: (608) 123-4567

Counselor name is required.

Grade level is required. Graduation date is required.


Your post-graduation plans are required.

If you are currently a client of the Division of Vocational Rehabilitation (DVR), please list:

Representative's name is required. District number is required.

Representative's name is required. District number is required.

A local newspaper is required.

School and Community Involvement
Below, please briefly list your involvement with your school and community. This may include any offices you held, club memberships, after school activities, work or volunteer experiences. List the length of involvement, the grade level you were in at the time of participation, and the name of an adult you worked with.
Please provide the: Activity Name, Adult Contact, Dates, and Grade Level!


Some school activities are required.


Some community activities are required.

Letters of Recommendation
When you have completed this form and you select the "Submit Your Application" link below, your email client will open. Before sending, please attach three Letters of Recommendation, which describe your demonstrated leadership skills or your leadership potential. At least two letters must be from people who are NOT related to you.
Below, please list the Name, Position/Title, Organization, and Telephone Number of the three people you have asked to write these letters.


A recommendation is required.


A recommendation is required.


A recommendation is required.


Required Essays
Your answers to the following questions will be used to assess your readiness to participate in this leadership and career awareness forum. Your total response should not exceed the equivalent of one typewritten, double-spaced page per question, or about 500 words.

Alternative Formats are Welcome: Please limit video or audiotapes to no more than 6-8 minutes per question. You may also choose to answer the questions as a poem or song if it helps you express yourself more clearly. When you have completed this form and you select the "Submit Your Application" link below, your email client will open. Before sending, you may choose to attach a small digital audio or video file. If you prefer to mail such files on a CD or DVD, please send to:
CESA #2, Attn: Youth Leadership Forum, 448 E. High St., Milton, WI 53563.

(Please limit your answer to 500 words).

An essay answer is required.

The Youth Leadership Forum is designed to teach you skills to increase the leadership skills you already possess. If you are selected to represent your school and community at the YLF, how will you use this information when you return to your school and/or community? (Please limit your answer to 500 words).

An essay answer is required.


A referral is required.

Before Submitting
When you have completed this form and you select the "Submit Your Application" link below, your email client will open. Before sending, be sure to attach:
3 Letters of Recommendation, and
Any pertinent small digital audio or video files

Please keep a copy of your completed application in your email Outbox for your records.