YOUTH SALUTE APPLICATION DOWNLOAD – Application Packet & Directions Please enable JavaScript in your browser to complete this form.1Contact Information2Leadership Roles, Activities, & Honors3Student Biography4Leadership Essay5Submit*Please have your student biography and leadership essay ready to upload when you fill out this application. Instructions for the student biography and leadership essay can be found in the application packet.High School *Pick your school....OtherAnderson CountyBath CountyBerea CommunityBourbon CountyBoyle CountyBryan StationBurgin IndependentCarter G WoodsonCasey CountyDanville Christian AcademyDanville High SchoolEast JessamineEstill CountyFleming CountyFrankfort Christian AcademyFrankfort HighFranklin CountyFrederick DouglassGarrard CountyGeorge Rogers ClarkHarrison CountyHenry ClayHenry CountyHome SchoolKY School for the DeafLafayetteLewis CountyLexington CatholicLexington Christian AcademyLincoln CountyMadison CentralMadison SouthernMenifee CountyMercer CountyModel LaboratoryMontgomery CountyNicholas CountyOwen CountyParis HighPaul Laurence DunbarPowell CountySayreScott CountySomerset ChristianSomerset HighSTEAM AcademyTates CreekTrinity ChristianWashington CountyWest JessamineWestern HillsWoodford CountySchool Name *Student First Name *Student Last Name *Student Contact Information Student Home Address *City *State *Zip *Student Phone Number *Student Email *EmailConfirm EmailA copy of your application will be sent to the email address entered here.Parent/Guardian Contact InformationFirst Name - Primary Parent/Guardian (Usually Mother) *Last Name - Primary Parent/Guardian *Phone Number - Primary Parent/Guardian *Email - Primary Parent/Guardian *EmailConfirm EmailFirst Name - Secondary Parent/GuardianLast Name - Secondary Parent/GuardianPhone Number - Secondary Parent/GuardianEmail - Secondary Parent/GuardianEmailConfirm EmailNext2 QUALIFYING LEADERSHIP ROLESStudents must have held or currently hold 2 leadership roles to which they were chosen by their peers or an adult leader within the past two years in school, religious or community sponsored organizations. Spell out complete names of clubs and organizations, no abbreviations. QUALIFYING LEADERSHIP ROLE 1 (Organization/Role/School Year) *QUALIFYING LEADERSHIP ROLE 2 (Organization/Role/School Year) *ADDITIONAL LEADERSHIP ROLES, ACTIVITIES, & HONORSUse the fields below to LIST all other leadership roles, activities, and honors you would like the committee to know about. You may enter (and we encourage) multiple items per field. Fields may be left blank if they do not apply to you. Spell out complete names of clubs and organizations, no abbreviations. SCHOOLSTATE/NATIONALVOLUNTEER SERVICESPORTSCOMMUNITYRELIGIOUSPreviousNextType (or copy & paste) your student biography in the field below. In a LIST, no paragraphs. *PreviousNextCopy & paste your Leadership Essay in the field below. *Due to technical difficulty with the file upload, we are asking you to copy and paste your essay here instead of uploading a separate document. With this format, it does not need to be double spaced. PreviousNextParent/Guardian Agreement - The information contained herein is correct. I hereby give consent for all information provided herein and photographs taken of the student in conjunction with the Youth Salute program to be used for publicity/social media/website, and display in school/community by Holifield Photography. I hereby release the National Council on Youth Leadership, the Central Kentucky Council on Youth Leadership, Holifield Photography, their employees and volunteers, from any liability resulting from injuries or illness sustained while participating in the Youth Salute program. *Parent/Guardian Name and DateStudent Agreement - The information contained herein is correct. I understand that false or misleading information contained in this application may be grounds for exclusion from the Youth Salute program and loss of any scholarships or awards received. I have read the program requirements listed above and agree to participate in all activities of the Youth Salute recognition. I hereby give consent for all information provided herein and photographs taken of myself in conjunction with the Youth Salute program to be used for publicity/social media/website, and display in school/community by Holifield Photography. *Name and DateHow did you hear about Youth Salute?... *School CounselorTeacherSchool AnnouncementSigns at schoolFriendFamilyClass 101Do you have a sibling that participated in Youth Salute in the past? *YesNoSecurity Question - Lets make sure you're not a robot... * = CommentSubmit