Last Name Your last name is required.

First Name Your first name is required. Middle Initial

Gender:

Male
Female
Please make a selection.

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

Residence Address We require your residence address.

City Your city is required. State Your state is required. ZIP Your ZIP is required.

Mailing Address (if different from above

Mailing City Mailing State Mailing ZIP

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

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

I Check Email Regularly:

Yes
No
Please make a selection.

Name of High School Your high school is required.

High School Mailing Address: City Your high school city is required. State Your high school state is required. ZIP Your high school ZIP is required.Invalid format.

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

High School Counselor's Name Counselor name is required.

Grade Level on Jan. 1, 2010 Grade level is required. Expected Graduation Date Graduation date is required.

Please tell us about your plans for after you graduate from high school.
Your post-graduation plans are required.

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

Rehabilitation Counselor's Name

Rehab Counselor's Phone

State Senate Representative’s Name Representative's name is required. District Number District number is required.

State Assembly Representative’s Name Representative's name is required. District Number District number is required.

Please provide the Name, City, State, and ZIP of at least one Local Newspaper 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!

School Activities
Some school activities are required.

Community Activities
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.

Recommendation 1
A recommendation is required.

Recommendation 2
A recommendation is required.

Recommendation 3
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.

What is one thing you have done in your life that you are really proud of?

(Please limit your answer to 500 words).

How I Will Use My Leadership Skills

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).

Who (name and title) referred you to this application?
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.