Youth Leadership Birmingham Application

Applications are due on Friday, September 26 by 11:59 PM. Prior to completing this application, please see the program calendar and make sure you can commit to full attendance.

Today's Date*
Attendance Policy Confirmation*
- Yes, I understand the attendance policy and can commit to full participation in YLB if I were to be selected as a member of the YLB Class of 2026.
*Note: All area superintendents and principals have excused absences for YLB on scheduled program days and you will receive an attendance verification for all days.
Personal Information
Name*
First Middle Last
Preferred name (printed on nametags:)*
Have you submitted an application to YLB in the past?*
- Yes
- No
Gender*
Race*
Date of Birth*
Month
Day
Year
Current Grade*
- 10th Grade
- 11th Grade
School*
Phone*
Email*

Please be sure you type this correctly as this will be the address we use to communicate with you!
Home Address*
Street Address Address Line 2 City State ZIP Code
Names of Parent(s)/Guardian(s)*
Parent/Guardian Email:*
Parent/Guardian Phone*
School Experience
Other Schools Attended*
GPA*
GPA Scale*
Organizations & Activities
In order of importance to you, list up to five school, volunteer, religious, social, athletic, or other activities or organizations in which you have participated during the last four years.*
Organization / Activity Grade in School Leadership Responsibility / Involvement
Work Experience
List any job experience, paid or volunteer, and briefly tell what it involved:
Do you currently have a part-time job?*
- Yes
- No
If you have a part-time job, how many hours do you work per week?
General Information
In a few sentences, describe yourself*
What issues concern you most about your community?*
What program session interests you most, and why?*
What do you expect to get out of YLB?*
If selected, what leadership attributes will you bring to YLB?*
Please respond to the following question in 250 words or less. If you could change anything in your community, what would it be, why, and how would you make the change?*
List the name and email of your reference. IMPORTANT: You will need to send them a link to the online reference form to complete. https://leadershipbirmingham.org/youth/references/*
If selected as a Finalist, you will need to interview in person on Monday, October 20th. Interviews are conducted in 30 minute time slots between 4:00pm and 7:30pm. If you are not available at ALL during that time frame, please do not apply. Unfortunately, there is no alternative date to interview.
- I understand that interviews take place ONLY on the afternoon/evening of Monday, October 20th.

Organization / Activity	Grade in School	Leadership Responsibility / Involvement

Youth Leadership Birmingham Application

Personal Information

School Experience

Organizations & Activities

Work Experience

General Information