First Name *

Last Name *

Preferred Name

Mailing Address (Line 1) *

Mailing Address (Line 2)

Date of Birth *

Gender *
Select OneMaleFemalePrefer not to sayPrefer to self-describe

Ethnicity *
Select OneWhite/CaucasianBlack or African AmericanAsian (East Asian, South Asian, Southeast Asian)American Indian or Native AmericanNative Hawaiian or Other Pacific IslanderHispanic

Grade Level during the 2026-2027 Academic Year *
Select One9th Grade10th Grade11th Grade12th GradeCollege FreshmanCollege SophomoreCollege JuniorCollege Senior

School Attending in the 2026-2027 Academic Year *

Current Unweighted GPA (Enter N/A if you are a rising freshman) *

Student Email Address *

Student Phone Number *

What gender would you prefer for clothing options? *
Select OneMen’sWomen’s

What is your shoe size? *
Select One567891011121314

What is your apparel size? *
Select OneXSSMLXLXXL

Parent / Guardian First Name *

Parent / Guardian Last Name *

Parent / Guardian Email Address *

Parent / Guardian Phone Number *

What profession or field do you hope to pursue in the future? *

Why are you interested in joining the Young Executive Leadership Academy? *

What qualities do you believe make a good leader? *

How have you shown leadership in your school, home, or community? *

Describe a time you worked with others to accomplish a goal. What role did you play and what did you learn? *

What do you hope to gain from this leadership academy, and how will you apply what you learn? *

Commitment Statement *

Type your full name (Student Signature) *

Date *

Parent / Guardian Consent *

Type your full name (Parent / Guardian Signature) *

Date *