Leadership for America – Application Personal InformationName* First Last Father's Name* Mother's Name* Address* City* State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZip* Home Phone Number*e.g. 123-456-7890Cell Phone Number*e.g. 123-456-7890Phone Number of Parent (emergency use only)*e.g. 123-456-7890Email Address - Student* Email Address - Parent* Date of Birth* Month Day Year EducationSchool Currently Attending* Graduation Year from High School* e.g. 2018Grade Point Average* Extracurricular Activities*MiscellaneousElectronic Signature for Photo Release (enter YES to accept) Parents must sign for applicants under 18 years of age. I hereby authorize and consent to the use and reproduction by YSI staff or an authorized agent or assignee of any and all photographs taken of the above-named applicant for the purpose of promoting YSI programs, without any compensation to me. All film, together with any prints, shall constitute property of YSI, solely and completely.Reference* Who recommended this program to you?CommentsEssay*Please insert an essay (about 200 words) explaining why you are interested in attending this seminar. You may want to draft your essay prior to completing the online application and then copy and paste it into the box provided.