2015 Youth Leadership Program Candidate Information The FBI National Academy Associates, Inc. (FBINAA), an organization comprised of law enforcement professionals who are graduates of the FBI National Academy, Quantico, Virginia, is offering to qualified Students (AGES 14 16) who have demonstrated above average academic standards (3.0 or higher on a 4.0 scale), as well as good citizenship, the opportunity to participate in an eight day program of leadership development at the FBI Academy/DEA facilities in Quantico, Virginia This exciting program is offered through the cooperation of the FBI and DEA, and individual participants are selected and sponsored by the various state chapters of the FBINAA, who will pay transportation and student sponsorship fees. This year, participants will also be included from our sister organizations, including LEEDA, NEIA, and the Society of Former Special Agents of the FBI. Further, the counselors and instructional staff for the program consist of National Academy graduates who are members of the FBINAA and select FBI Special Agent personnel. Guest lecturers in various professional disciplines also address the students. Although the program is not limited to young persons interested in a future career in law enforcement, interested candidates should possess a desire to gain knowledge of the American system of criminal justice, as well as ethics, leadership skills and personal development. This year s session of the Youth Leadership Program begins June 13, 2015 with arrival at Reagan Airport in Washington, D.C., and will conclude on June 20, 2015 with departure from Reagan Airport in Washington, D.C. The program is open to males and females. Qualified young people are encouraged to complete the application, including the necessary signatures, and to submit the forms to the designated FBINAA Chapter Youth Leadership Program Representative by the due date of MARCH 13, 2015. The Chapter must make selection and submission of all required material to the FBINAA Executive Office by APRIL 17, 2015. Application forms are available thru the FBINAA Chapter Youth Leadership Program Contacts. 2015 YLP Form 01
2015 YOUTH LEADERSHIP PROGRAM Sponsor -Chapter Instructions The information included herewith will assist your chapter/association should you decide to sponsor a candidate to this year s session of the FBI National Academy Associates (FBINAA) Youth Leadership Program. Aside from the basic requirements, high school students, must be physically and medically fit to meet the program activities, demonstrate good citizenship and have a GPA of at least 3.0 (on a 4.0 scale). Applicants must also submit a one-page essay entitled What is Leadership? and undergo an oral interview conducted by a screening committee composed of active members of the sponsoring FBINAA, Inc. Chapter or sponsoring association. All forms must be submitted with the application. Forms other than those labeled 2015 will be returned. To assist you in the selection process, an optional form called The Qualification Matrix is also provided for your use. Selection of your candidate is solely the decision of your chapter/association. The following is an overview of the slot allocation process: The program has increased the number of students to a maximum of 60. The selection process will allow each domestic and international chapter one (1) slot (48 total). The five (5) largest NAA chapters will automatically receive a second slot each year. (Those are California, New York/E. Canada, Florida, Illinois, and Texas) Those chapters may submit 2 candidates for acceptance. Our sister organizations will each receive one (1) slot, meeting the same requirements we have regarding membership, etc. (They are The Society of Retired Special Agents of the FBI, LEEDA, NEIA). In the event they do not select anyone, the extra slot(s) will be rotated through each of the Sections starting in Section 1, 2, 3, 4. The four (4) remaining slots will go to each of the four sections and the decision on who gets that slot will be decided by the Chapter Presidents or designee. Any slot not taken in a Section by a Chapter will be retained in that Section. Applications received after April 17, 2015 will not be accepted. Consideration may be given to announcing your chapter s/association s recruitment efforts to local schools. Selection of students outside of the FBINAA membership is at 2015 YLP Form 02
the Chapter s discretion. Please insure that your candidate is physically capable of participating in ALL of the program activities. You are also encouraged to seek financial support available in your community to offset the $500.00 sponsorship fee the chapters/associations must provide for each candidate s attendance. Additionally, chapters/associations must provide candidate s airfare and transportation costs. Sponsorship fees are used to pay incidental expenses related to field trips and excursions in the Washington, D.C. area that are included in the curriculum. In the event that a candidate withdraws or is dismissed from the program, the parent/guardian will be responsible to reimburse the chapter/association for any costs expended at the chapter s/association s discretion. The name of your chapter s candidate should be submitted to: YLP Program, FBINAA, 422 Garrisonville Rd., #103, Stafford, VA 22554, together with the following required documentation: 1. Completed Application Form. 2. Completed General Information Form with ID Photo. 3. Signed Physician Medical Release Form. 4. Scholastic Certification Letter. 5. Completed and signed Typed Written Essay. 6. Completed Oral Interview Rating and any other form used in the selection process. 7. Copy of all forms submitted. 8. Chapter/association sponsorship fee of $500. 2015 YLP Form 02
2015 YOUTH LEADERSHIP PROGRAM APPLICATION Name: (M/F) Age (DOB) Address: E-mail: City: State: Zip Code: Telephone: Area Code ( ) - Cell Phone: ( ) - School: City: State: Employment: City: State: Name(s) of Parent(s) or Legal Guardian(s): Address: City: State: Telephone: Area Code ( ) - Cell Phone: ( ) - Name of Employer: Telephone: ( ) - E-mail: Please list any Sports, School Clubs/Activities/Offices, Hobbies, and Special Interests/Talents What do you expect to gain from attending the Youth Leadership Program? Applicant s Signature: Date: Print Name: 2015 YLP Form 03
ATTACH RECENT PHOTO HERE January 2015 Parental Consent I UNDERSTAND MY SON/DAUGHTER WILL BE ATTENDING THE YOUTH LEADERSHIP PROGRAM AND EXCEPT WHILE TRAVELING ON A COMMERCIAL AIRLINE OR CONVEYANCE, WILL BE UNDER THE CONSTANT SUPERVISION OF A MEMBER OF THE FBINAA, Inc. WITH THIS UNDERSTANDING I APPROVE OF HIS/HER PARTICIPATION IN THIS PROGRAM. I FURTHER CERTIFY THAT HE/SHE IS MEDICALLY AND PHYSICALLY FIT TO PARTICIPATE IN ALL PROGRAM REQUIREMENTS. I UNDERSTAND THAT SHOULD MY SON/DAUGHTER LEAVE THE PROGRAM PRIOR TO COMPLETION I AM RESPONSIBLE FOR COSTS INCURRED BY THE SPONSORING FBINAA CHAPTER AT THEIR DISCRETION. Parental/Guardian Signature: Date: Print Name: Emergency Telephone Number: ( ) - (IMMEDIATE RESPONSE) Emergency Contact Name: List any physical limitations or medical problems of the son/daughter that staff must be aware of: A Medical Release Form (YLP Form 04) will be required prior to acceptance to the program. (To be completed by Sponsoring FBINAA, Inc. Chapter) Return Completed Application to: President: FBINAA Chapter: Street Address: City: State: Zip Code: FBINAA Chapter Submission Deadline: April 17, 2015 Applications received after this date will not be accepted. This MUST be completed by candidate: Candidate s Sponsor: Session: Member #: 2015 YLP Form 03
2015 Youth Leadership Program MEDICAL INFORMATION/RELEASE FORM Required Information Name DOB SS# Address City State Zip Home Phone Cell Phone e-mail FBINAA Sponsoring Chapter (PLEASE ANSWER ALL QUESTIONS. IF NOT APPLICABLE INDICATE AS SUCH.) List any impairment: mobility, sight, hearing or speech etc. If so would any special assistance be required? List any medical problems emergency personnel should be aware of and any medications the student is presently taking: List all allergies: In the event that he/she should be unable to communicate with medical personnel, list specific information they would need to know about medical history and ailments: EMERGENCY NOTIFICATIONS In case of emergency, please notify the following: Name Relationship Phone Name Relationship Phone In the event of any sudden illness or medical emergency occurring to my son/daughter, by my signature I expressly grant the FBI/FBINAA full authority to 1) release the above medical information to emergency or medical personnel and 2) perform any necessary medical emergency treatment to my son/daughter after reasonably diligent efforts to notify me have failed. I will personally fill out the File of Life packet and I will instruct my son/daughter to carry it at all times while traveling to, from and at the program. Signature Relationship Date STATE OF COUNTY OF, to-wit: The foregoing was acknowledged before me this day of, 2015, By. Notary Public My Commission Expires: 2015 YLP Form 04 PHYSICIAN CERTIFICATION I have read the Youth Leadership program syllabus and activity requirements. I have examined and certify that he/she is physically fit to meet ALL of the activities including the 4.25 mile USMC Endurance/Stamina Course (Yellow Brick Road). Physician Signature DEA/ID # Physicians Name Phone *Return this form with the Registration Packet *
2015 Youth Leadership Program ESSAY What is Leadership (Use other side if necessary) Signature: Print Name: 2015 YLP Form 05