COBB COUNTY

COBB COUNTY

Home

PARTICIPANT APPLICATION
for the
2008-2009 COBB YOUTH LEADERSHIP
DEVELOPMENT PROGRAM

INSTRUCTIONS:
This application must be completed in its entirety. Any application that is incomplete will not be considered.

To be eligible for selection, all applications and forms must be postmarked/submitted by Monday, April 28.

Any application that is incomplete will not be considered.

BASIC INFORMATION
Full Name
Name Called
Date of Birth
Race
Male/Female
Mailing Address*
City*
State*
ZIP*
Home Phone*
Mobile Phone
E-mail Address
Family E-mail Address
Father/Guardian Name
Emergency Number
Mother/Guardian Name
Emergency Number
ACADEMICS
Grade as of August 2008
High School
Grade Point Average
Academic honors received (please list)
CURRENT EXTRA-CURRICULAR ACTIVITIES
List here (1) school activities, clubs, athletic teams; (2) community and volunteer activities; (3) employment if applicable
LEADERSHIP EXPERIENCE
List offices/leadership positions held in clubs or organizations, project you directed/initiated if applicable
Do you know a Leadership Cobb Graduate? (This is the adult version of Cobb Youth Leadership	YesNo
If yes, name and relationship
What personal characteristics/qualities do you have that you feel give you the potential to be a leader?
How would you complete this sentence? In ten years I see myself...
If you are selected, how could Cobb Youth Leadership help you in achieving the above?
TUITION FEE
A tuition fee of $350 is required to help offset the cost of materials, meals and lodging. Leadership Cobb Alumni Association may provide a scholarship (1 per year) to someone requiring financial assistance based on need. (Check One)
	I will not require financial assistance in order to participate.
	I will require financial assistance in order to participate.
Please explain why financial assistance is needed. (Must be completed by parent or guardian.
Please note: Your letter of recommendation from a teacher, employer, or friend of the family should be sent separately from your application.

Need help? Questions? Contact Katie Edfeldt at kedfeldt@cobbchamber.org or 770-859-2334.