2027 Youth Leadership Long Beach Application

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Youth Leadership Long Beach Application

First Name *

Last Name *

Address 1 *

Address 2

City *

State/Province *

Zip *

Phone *

Email *

Emergency Contact Information

Caregiver/Guardian Name *

Caregiver/Guardian Relationship *

Caregiver/Guardian Email *

Caregiver/Guardian Phone *

Demographic Information

Date of Birth *

Which high school do you attend? *

What grade are you entering in fall? *

What academic and co-curricular activities have you committed to for the coming 2026-27 school year?

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Additional Information

How did you hear about Youth Leadership Long Beach? Please select all that apply: *

Teacher

School Counselor

Principal/Other School Staff

School Announcement/Bulletin

Leadership Long Beach Graduate

Youth Leadership Long Beach Graduate

Directly from Youth Leadership Long Beach

Other

Caregiver, Adult Relative, or Adult Friend

Community/organization leader

If you selected other, please explain:

Why do you want to participate in the Youth Leadership Long Beach program? *

Please rate your interest in leadership: *

Please rate your interest in environmental sustainability and local community impact: *

Have you ever taken a class, course, camp experience, workshop, or other educational experience that discussed leadership principles including leadership styles or perspectives? *

Yes

If your answer was yes, please describe your experience. If your answer was no, please tell us what barriers prevented you from participating: *

Have you ever taken a class, course, camp experience, workshop, or other education experience that covered environmental sustainability? *

Yes

If your answer was yes, please describe your experience. If your answer was no, please tell us what barriers prevented you from participating: *

Have you ever participated in community service? *

Yes

If your answer was yes, please describe your experience. If your answer was no, please tell us what barriers prevented you from participating: *

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Short Essay Response

Please select ONE of the following four prompts for your short essay response. You will have space to respond to the prompt you selected below:

1. Choose one significant personal experience that has shaped your life. What was the experience? How has it shaped your life?

Select this prompt.

2. Give an example of a time when you have been challenged to step out of your comfort zone. How did you deal with the situation? What did you learn? What would you have done differently?

Select this prompt.

3. Describe the most important leadership role you have had, either in your school, community organization and/or in your community service? Describe the nature of the activity and how you became a leader. What did you learn as a leader?

Select this prompt.

4. Describe how your role models, heritage, family upbringing, and/or educational experiences have influenced your life experience including your academic and personal goals.

Select this prompt.

Please write your response to the prompt you have selected here: *

Time Commitments

Will you commit to attend and participate in the following Youth Leadership Long Beach (YLLB) activities?

We expect you to attend the YLLB sessions, October retreat, MLK parade and Day of service, service project and the program graduation.

One Youth Leadership Long Beach Class Day per month (5 hour class day) *

Yes

If you miss more than two session, you will be expected to meet with the Director of Programs to discuss your further participation.

Youth Leadership Long Beach Welcome and Retreat Orientation will be held on Sept. 12 from 10 a.m. to 3 p.m. Will you be able to attend this required session? *

Yes

If you are unable to attend on Sept. 12, please give us the reason.

Youth Leadership Long Beach Retreat, is required and scheduled for Oct. 2-4, 2026. (We will be leaving at 4:00 pm on Friday and returning by late afternoon on Sunday.) *

Yes

Will you commit to participate in the YLLB service experience in the Spring? *

What would be a reason that you might not be able to participate in the YLLB service opportunity?

Would you like to add anything else to your YLLB application?

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