Successteam Jr. Leadership Academy Application

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Successteam Jr. Leadership Academy Application

Leadership starts early. Enrollment for the next Successteam Junior Leadership Academy is now open. Seats are limited and fill quickly.

Program Details

Eligible Grades : 7th–8th
Program Fee : $50 + transaction charges
Includes : Admission, curriculum materials, lunch, and program t-shirt
Duration : One-day immersive leadership experience
Location : Details provided upon registration

Student Information & Profile

First Name *

Last Name *

Date of Birth *

Age *

Gender *

Race/Ethnicity *

Hispanic or Latino

American Indian or Alaska Native

Asian

Black/African-American

Native Hawaiian or Other Pacific Islander

White

Two or More Races

Prefer not to answer

Biracial

Current Middle School *

Current Grade Level *

Rising Grade Level *

(Grade You Will Be In Next School Year)

Shirt Size *

Phone Number *

Email Address *

Please refrain from using iCloud email address

Mailing Address

Home Address *

Address Line 2

City *

State *

ZIP Code *

Parent/Guardian Details

Parent/Guardian Full Name *

Phone Number *

Email Address *

Relationship to Student *

Mother

Father

Grandparent

Annual Household Income *

Reflection Question: As a parent or guardian, what do you hope your student will gain from the Successteam Youth Council? *

Photo Release Consent *

By submitting this application, I grant permission for Successteam to use my student’s image or likeness for program materials and media purposes.

Acknowledgment & Signature *

By submitting this application, I affirm that the information provided is accurate to the best of my knowledge.

Admission Fee

0.00

For payment, you will be redirected to secure Stripe payment page.

For any query please contact us now