Alaska Youth Leadership Forum Participant Application Alaska Youth Leadership Forum Participant Application Applicant Name(Required) First Last Date(Required) MM slash DD slash YYYY Preferred Name First Email(Required) Applicant Phone #(Required)Parent/Guardian Name(Required) First Last Parent/Guardian Email Parent/Guardian Phone #Date of Birth(Required) MM slash DD slash YYYY Applicant Age (14-24)(Required)Residence Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Mailing Address (If Different from Above) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Applicant Ethnicity American Indian or Alaska Native Asian Black or African American Hispanic Native Hawaiian or Other Pacific Islander White Other Other Ethnicity: What is your disability/disabilities (please be as specific as possible)(Required)What areas of your life do you notice that your disability/disabilities challenge you?(Required)Applicant Current Grade or Education Level(Required)(Please select)9th Grade10th Grade11th Grade12th GradeCurrently in collegeCollege graduateTrade & vocational schoolAre you a student?(Required) Yes No If Yes: Expected graduation date MM slash DD slash YYYY If Yes: Name and City of School Attending Please list your involvement with your school and/or community. This may include community activities, group or club memberships, leadership positions you have held, service to others you have completed, after school activities, and/or work experiences you have had. Work: what kind? School: for what? Volunteer: where?(Required)What are your future educational plans or goals? If you are not a student, and do not plan to return to school, please share any learning opportunities you may be considering.(Required)What are your current work or career plans or goals?(Required)In terms of leadership, please tell us about two people who have positively influenced your life, and how they did so?(Required)Please describe any plans you have for your future, such as: what you wish to explore, accomplish, change, or do, in relation to your home life and involvement in the community.(Required)Accommodations, Support, Technology Individualized support, assistance, and resources will be celebrated and honored, and a variety of avenues for self-expression and interaction will be embedded throughout Alaska Youth Leadership Forum (YLF).Please check the boxes below that are true for you. Your responses are to assist us with planning, and do not impact your opportunity to participate in any way:(Required) I will need an ASL Interpreter to participate in Alaska YLF I will need Captioning to participate in Alaska YLF I will need support with reading, writing, or typing to participate in Alaska YLF I use a screen reader, or other form of assistive technology that will need to be checked for compatibility prior to participating in Alaska YLF I have a tablet or laptop I can bring to use at Alaska YLF I need a tablet or laptop supplied to me for Alaska YLF I don’t need any accommodation. I need an accommodation not listed Please list Accommodation Expectations for Success All Participants at the Alaska YLF conferences are expected to contribute to a positive and productive culture, and must: Communicate with Alaska YLF Conference planning team members regarding conference logistics and return of required documentation. Return all required information by established deadlines, and prior to participation. Adhere to all Health and Safety Protocols prior to and during the conference. Prioritize Alaska YLF, and plan to be fully present for all conference activities. Maintain an equitable and respectful attitude toward peers, presenters, and facilitators. Headsets, radios, electronic devices, and cellular phones that are not being used for participation in Alaska YLF are not permitted during scheduled Alaska YLF activities. Use of such items will be permitted during designated breaks unless their use has been identified as a reasonable accommodation. Parents/Guardians/Other Supporters will be asked to allow youth time and space, free from interruption, throughout the Alaska YLF conference, to maximize their opportunity to learn and grow, challenge themselves, and engage to the fullest. Optimal times for checking in will be shared during orientation and in follow up communication. Submission of your confirmation form includes your acceptance of, and agreement to, following these expectations.Did anyone assist you in completing this application? Yes No If yes, please specify who Did someone refer/encourage you to submit this application? Yes No If yes, please specify who Please type your name as you wish it to appear on your Alaska YLF graduation certificate(Required) By signing my name below, I attest that I understand the information herein, and that this application is accurate to the best of my knowledge: Type Name:(Required) Parent/Guardian Signature (if applicable): By signing my name below, I attest that I understand the information herein, and that this application is accurate to the best of my knowledge: *Type Parent/Guardian Name Any follow-up information you need, or additional materials required from you will be emailed to you soon. If you have more immediate questions, or if you have difficulty completing this online form, please email: info@AlaskaSILC.org, or call 907-263-2011. We are here to help and support your journey in any way we can! Δ
