Young Leaders Institute Application Program InformationYoung Leaders Institute (YLI) offers high school sophomores an opportunity to grow as leaders, learn about career pathways, and explore their community. Applications are due by Friday, September 8, 2023. Candidates selected for the program will possess a sincere commitment, motivation, and interest to develop leadership skills and serve the Richland County community during their high school years. A selection committee will review all completed applications. Applications will be notified of a program admissions decision by Friday, September 29, 2023.Student InformationFull Name *Preferred NamePreferred PronounsGender *Personal Email *School Email *Mobile Phone *Home Address *City *State *Zip Code *School Name *Student Leadership InformationList School Involvement/Leadership Positions *List Community Involvement/Leadership Positions *Briefly describe your interest in Young Leaders Institute, what you hope to gain, and how you expect to utilize your program experience. *What does the word "leadership" mean to you? *Please give an example of an impactful use of leadership skills, either that you accomplished or that you observed in someone else. *What would your theme song be? *ReferencePlease list the information for a teacher, career counselor, or guidance counselor. They will be contacted to complete a reference form.Name *School District *Email *Phone *CommitmentTo graduate from Young Leaders Institute, a participant must meet these attendance requirements: First Thursdays, October through March from 9 a.m. to 1:30 p.m. (one absence permitted) Will you be able to meet the attendance requirements? *YesNoWill you be able to meet at the program starting locations in Mansfield by 9 a.m. should your school district be unable to transport you? *YesNoAre you currently at 10th grade student enrolled in a Richland County school district or homeschool? *YesNoT-Shirt Size *T-Shirt SizeSmallMediumLargeX-LargeXX-LargePlease select your t-shirt size.I understand the purposes of the Young Leaders Institute program and, if I become a participant, I will devote the time and energy necessary to make it a successful experience and will use this experience to develop my leadership skills in my school the community.Student Signature *Start signing your signature hereYour browser does not support e-Signature field.Parent/Guardian InformationName *Your Relationship to Student *Email Address *Phone *Home Address *City *State *Zip Code *Emergency Contact Name *Other than yourselfEmergency Contact Phone *Emergency Contact Relationship to Student *Parent/Guardian Liability Release *I agreeRecognizing the educational benefits of this program and acknowledging that it is voluntary, I agree to assume responsibility for my child’s safety and welfare while participating in the Young Leaders Institute program and hereby release the Mansfield Richland Area Educational Foundation and its agents from any liability for injury or damage arising out of the program.Parent/Guardian Medical Release *I agreeA physician will treat your child if the need arises while he/she is attending the program. In the event of serious illness or injury, you will be notified. If you are unavailable, necessary emergency treatment will be arranged.Please list the student's allergies.Parent/Guardian Transportation Release *I agreeYour student will be transported by a school district or charter bus service to locations in Richland County for the purposes of the program.Promotional Release *I agreeI give Mansfield Richland Area Educational Foundation permission to use my child’s photo in various social media posts, advertising and promotional brochures.Is there anything else we need to know about your student to ensure they have a wonderful experience in the Young Leaders Institute program?Parent/Guardian Signature *Start signing your signature hereYour browser does not support e-Signature field.Mansfield-Richland Area Educational Foundation does not discriminate on the basis of race, color, national origin, sex, disability, age or religion. SubmitSave as Draft