LEADERSHIP PROGRAM APPLICATION PACKET

LEADERSHIP PROGRAM APPLICATION PACKET 2017-2018 Our community-based Leadership Program provides a fun, safe and challenging experience for high school juniors (sophomores and seniors by special arrangement) to develop their leadership skills, explore potential careers, learn about the issues and challenges facing our communities, meet the leaders of the organizations working to address them, and learn how to participate effectively. Applicants will be selected based on: this application, two reference forms an interview Our goal is to create a group that will not only benefit from the experience, but will contribute to both the TLT program and to their communities. To apply, please answer each of the following questions legibly using blue or black ink. In addition to the completed application, you will need the following: Signatures from you and your parent/guardian (see Expectations & Commitments page) Approval from your school principal to participate in the program (Expectations & Commitments) Reference forms completed by two different adults (forms included with this application packet) All forms will be handled in the strictest confidence. If you need additional application forms, please visit the TLT website: www.tomorrowsleaderstoday.org or call 707-206-7494, or admin@tomorrowsleaderstoday.org Completed Application Checklist: Applicant Information (1 page) Applicant Questions (2 pages) Reference Provider Information (1 page) Scholarship Application Form (1 page) only if you are applying for tuition assistance Expectations & Commitments (1 page) Reference Forms (1 page each) APPLICATION PACKETS MUST BE RECEIVED BY YOUR SCHOOL COORDINATOR NO LATER THAN MARCH 16, 2017. REMOVE THIS PAGE. Keep for your records. DO NOT TURN IN with your application

Program Overview WHAT: TLT is a year-long program that helps students achieve three goals: Leadership development: identifying the qualities and skills a person needs to be a leader now and in the future, and cultivating them through structured experiences; Career exploration: introducing a wide variety of industries and careers, and the skills needed for success in them; Community connections: understanding the issues and challenges our communities face, and connecting with the leaders of the organizations that make them work. We explore seven sectors of the community: human services agriculture criminal justice health care government environment & natural resources business & media WHEN: participants meet one day a month, during school. Most school districts consider participation in TLT to be an excused absence; students must complete the work they miss on those days. Additional non-school times typically include an evening Orientation and Saturday Retreat in August, a Financial Literacy segment on a Saturday morning in late fall, 8 hours of community service in December, and an evening graduation in the spring. WHERE: out of school, off campus, in the community. We visit homeless shelters, dairies, hospitals, city halls, government agencies, and a variety of local businesses. WHO: High school juniors (sophomores & seniors by special arrangement) Who live in Sonoma County (there is not yet a separate class for Sonoma Valley) Who are curious about their community and its challenges & issues, want to sharpen their leadership skills, and want to give back. They need not have extensive leadership experience already. COST: Once a student is accepted, a $50 non-refundable deposit is due in May. Tuition is an additional $600, and can be paid in installments, but must be paid in full by December 31. TUITION ASSISTANCE IS AVAILABLE, based on family financial need. Interested students should complete the Scholarship Request in the Application Packet.

LEADERSHIP PROGRAM APPLICATION 2017-2018 Applicant Information (Please PRINT CLEARLY) Name (Last) (First) (Middle) Name you prefer to be called Date of birth Home phone(s) Cell Phone: E-mail address Gender Street Address City State Zip Code Race or Ethnicity (optional) American Indian/Alaskan Native African-American/Black Asian Latino/Hispanic Native Hawaiian/Pacific Islander White/Caucasian School Current grade in school Which TLT class are you applying for? West (West Sonoma County Union HS District students) Santa Rosa North (Cloverdale, Healdsburg, Windsor) South (Petaluma, Cotati, Rohnert Park) Parent/Guardian Information Language spoken at home Name: Name: E-mail: E-mail: Cell phone: Cell phone: How did you hear about TLT? (check all that apply) Announcement at school Teacher or school staff told me about TLT Presentation in class Informational lunch meeting Parent/Guardian got an email about TLT Newspaper ad or article (what paper?) Other (please explain): School s web page Poster at school Friend who participated in TLT Friend who did NOT participate in TLT

Applicant Questions 1a. Choose three words to describe yourself. 1b. Then write about an experience or activity that shows these qualities in action. 2. What are your primary interests and activities? 3. Tell us about a personal accomplishment that makes you proud. 4. Describe a challenging experience. How did you handle it and what did you learn? 5. Describe any work experience (paid or volunteer) that you have had, including what you did and anything you gained/learned from it.

6. Describe your family and any unique qualities and experiences that make you who you are. 7. From your own experience and knowledge, what does a good leader look like and do? 8. Why are you applying for TLT and what do you want to gain from the program? 9. What problems (in your school, neighborhood, community, or ) would you like to learn more about and/or address?

Reference Provider Information Please submit this form with your application so the TLT Class Coordinator knows who will be providing references on your behalf. Applicant Name School Your Reference Providers May Include: 1. Any school teacher, counselor, advisor or coach; 2. Any other non-school adult who knows you well, other than your parent(s) or relatives(s) for example: a church leader, employer, scout leader or family friend. Reference Provider Name School/Firm/Organization Relationship to you Phone Number email Reference Provider Name School/Firm/Organization Relationship to you Phone Number email Instructions: Write your name, school and TLT class on your forms before giving them to your reference providers. Be sure to give your reference providers adequate time to complete your forms - at least 3-5 days! Ask your reference providers to return your form in a sealed envelope. Include both forms with your completed application by March 16 th. Additional Reference Forms can be downloaded from www.tomorrowsleaderstoday.org click the References tab. ALL Reference Forms must be attached to your application and received by March 16 th, 2017

Scholarship Application (Optional) Complete ONLY if you are requesting assistance with tuition. Tomorrow s Leaders Today is committed to ensuring that qualified young people can participate regardless of their family s ability to pay tuition. For that reason we have established a scholarship fund and award financial assistance based on need. A $50 non-refundable deposit must be paid by all TLT students upon ACCEPTANCE into the program. In addition, TLT tuition is $600, which helps to offset the costs of staff time and materials required to operate the program. Tuition can be paid in one or four installments, but must be paid completely by December 1 st. TLT offers scholarships of up to $600. Scholarships are awarded based on family income, size and other factors related to a family s ability to pay, as well as the financial assistance funds available. To apply, please complete the following questions. Your responses will be completely confidential and not shared with anyone outside of TLT including your child, schools, or any individuals or organizations. Student Name: School: Dollar amount of assistance requested (maximum $600): of scholarship) ($50 deposit must be paid by all, regardless What is your family s total annual household income? $ (Include child support, alimony, and aid) How many people live on that income? Does the student qualify for free or reduced price lunch at school? Does the student s family qualify for any aid (e.g. CalFRESH, CalWORKS, TANF, SSI)? Please list type and ANNUAL amount of aid: Please provide reasons for your request including any other special circumstances. You may attach an additional page if needed. Parent/Guardian Name: Phone: Best way to contact: Email: Language spoken: I certify that the above information is true and correct. I understand that completing this form does not guarantee that TLT will be able to award the requested financial assistance. Name Signature Acceptance packets will be sent out in May, and will include the amount of scholarship you were awarded.

Expectations and Commitments Page Connecting Youth to Leadership, Career, and Community Applicant Name: School: Expectations Successful completion of the TLT program and fully benefiting from it requires student commitment (and family support) to: Attend: a full-day retreat held on a Saturday in August/September, and at least 6 of the 7 program days held off campus on school days. School attendance credit is granted if students complete the Reflection (see below). Other TLT program activities include: a short evening Orientation in August, Financial Literacy experience, 8 hours of community service, and a graduation ceremony. Accommodations for students individual schedules can be discussed with the Coordinator of their class. Reflect: a short homework assignment due approximately a week after each program day, and a final paper, are required for program completion. Communicate: students must communicate via email with their Coordinator and classmates on a regular basis. Commitments Student: I commit to meeting the program expectations outlined above. Signature: Date: Parent/Guardian: I am aware of these program expectations and will support my student applicant to meet and complete them. I also understand that there is a deposit and tuition cost for this program and that we can apply for a scholarship, using the Scholarship Application form included in this packet. Signature: Date: Principal: I understand these TLT Program expectations and will support the applicant s full participation in the program, if s/he is selected. Signature: Date: Submit completed Application Packet to your school contact person by March 16, 2017. Applicant Information (1 page) Applicant Questions (2 pages) Reference Provider Information (1 page) Scholarship Application Form (1 page) only if you are applying for tuition assistance Expectations & Commitments (1 page) 3 signatures Reference Forms (2 reference forms are required; 1 page each)