Alameda County Youth Leadership Academy

This program is for High School Juniors and Seniors who live in Alameda County and attend an Alameda County school
1. Submitted by
This application is intended to be completed by students.  
*Is the high school student completing this application?:  
2. Applicant Info
*Last Name:   *First Name:  
*Address Line 1:   Address Line 2:
*City:   *State:  
*Zip:    
*Supervisorial District:   *Age:  years  
*Primary Phone:   *Phone Type  
*Email (please provide an email address you plan on using after high-school):   *Preferred mode of contact:  
3. Emergency Contact
*Last Name:   *First Name:  
*Phone number for Saturday Morning:   Relationship:
4. Parent Contact
*Last Name:   *First Name:  
*Address Line 1:   Address Line 2:
*City:   *State:  
*Zip:    
*Email Address:    
5. Other
*High School Name: *City:
*Transportation Method: *Class:
*Is your Parent/Guardian a current Alameda County employee?:
*Alameda County Youth Organizations you participate in:
*Special Accommodation:
Tell us why are you interested in the academy:  
*Areas of Interest : (Please select in order of preference):
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How did you find out about the Youth Leadership Academy?  
* Required information
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