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Youth Leadership Application

Please correct the field(s) marked in red below:

Thank you for your interest in the Dream Extreme’s Future Leaders Program.  Please complete the application and submit it to the City Clerk’s Department.

1
First Name
2
Last Name
 *
3
Grade
4
Address
5
City
6
Zip Code
7
Phone No.
8
High School
9
GPA
10

Internship: Please select two departments that you would be interested in interning with:

 *
Internship: Please select two departments that you would be interested in interning with:
11
In 200 words or less, describe why you would like to participate in the program:
 *
12
List all volunteer activities:
13
Please list 3 references with contact information (phone/email):
Please list 3 references with contact information (phone/email):
14

Mock Government: Please select two positions you would be interested in serving as: (** denotes an elected position, these positions will be elected from the participants)

 *
Mock Government: Please select two positions you would be interested in serving as: (** denotes an elected position, these positions will be elected from the participants)

**By signing this application, I am acknowledging my ability and commitment to participate in this program, complying with all requirements for completion and agreeing to abide by all rules and regulations associated with the program. **

Note: Prior to acceptance into the program, a release form signed by a parent/guardian and a school counselor/school administrator must be submitted to the City Clerk..  It may be emailed to sdomen@lake-elsinore.org.

15

Name (First/Last)

16
Emergency Contact Information
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