Apply for Summer Leadership Institute

Program Openings >> Summer Leadership Institute >> Apply

Please fill out the form below and click Submit to submit your application for consideration. Fields with an asterisk (*) are required.

Summary
Title:	Summer Leadership Institute
ID:	1025
Location:	Hagerstown, MD
Program:	Youth Camp
Program Cost Range:	$320.00
Contact Information
* First Name:
* Last Name:
Address 1:
Address 2:
City:
State:
Zip:
Phone:
* Email:
Opt-In Confirmation
	By submitting this application, I consent to receive SMS updates from Circle of Trust Inc at 8664029828 regarding my employment application. My information will not be shared or used for any other purposes. This application is powered by ApplicantStack on behalf of Circle of Trust Inc. SMS messages will only be sent by Circle of Trust Inc and are used exclusively for hiring-related communications when you have subscribed to receive SMS communications.

Summer Leadership Institute Application Form

1. APPLICANT PRIMARY CONTACT INFORMATION

* Applicant Last Name::

* Applicant First Name::

Applicant Middle Name::

Name you prefer to be called (if different from abve)::

* Gender::

	Male
	Female

* Date of Birth::

* Country of Birth:

* Current School::

* Current Grade::

* Applicant Phone Number
(Enter your parent number if you do not have a personal phone number)::

* Applicant Email Address:
(Enter your parent number if you do not have a personal phone number)::

* Mailing Address:

* City::

* State::

* Zip Code::

2. PARENT / GUARDIAN PRIMARY CONTACT INFORMATION

First Parent/Guardian

* Name of Parent/Guardian/Primary Contact::

* Cell Phone for Parent/Guardian/Primary Contact::

Work Phone for Parent/Guardian/Primary Contact::

* Email Address for Parent/Guardian/Primary Contact:

Mailing Address for Parent/Guardian:
(If different from above):

City for Parent/Guardian:
(If different from above):

State for Parent/Guardian:
(If different from above):

Zip Code for Parent/Guardian:
(If different from above):

Second Parent/Guardian

Name of Parent/Guardian/Primary Contact::

Cell Phone for Parent/Guardian/Primary Contact::

Work Phone for Parent/Guardian/Primary Contact::

Email Address for Parent/Guardian/Primary Contact:

Mailing Address for Parent/Guardian:
(If different from above):

City for Parent/Guardian:
(If different from above):

State for Parent/Guardian:
(If different from above):

Zip Code for Parent/Guardian:
(If different from above):

3. EMERGENCY CONTACT INFORMATION

First Emergency

* Name of Emergency Contact::

* Cell Phone for Emergency Contact::

* Relationship to Emergency Contact::

Second Emergency

* Name of Emergency Contact::

* Cell Phone for Emergency Contact::

* Relationship to Emergency Contact::

4. OTHER INFORMATION

* Are there other applicants you are hoping to attend the camp with?::

	Yes
	No

Name of Other Applicants::

* Are you planning to Drive or Fly to the Camp:

	Drive
	Fly

* If you are flying would you need a ride from the airport?:

	Yes
	No
	N/A

Is there anything else you would like us to know::

4. REFERENCES

Reference 1

* Name:

* Relationship:

* Phone Number:

* Email:

Reference 2

* Name:

* Relationship:

* Phone Number:

* Email:

5. SHORT ANSWER QUESTIONS

* Why would you like to attend the Summer Leadership Institute?

* What does leadership mean to you?

* Describe a time when you worked as part of a team. What did you learn from that experience?

* What are two personal strengths you hope to grow during this program?

* How do you hope to make a positive impact in your community, school, or faith life?

6. ATTACHMENT

* Do you have any allergies, dietary restrictions, or medical conditions we should be aware of?
(If yes, please specify in the space below):

	Yes
	No

Specify any allergies, dietary restrictions, or medical conditions::

* Are there any special accommodations or supports you may need during the week?
(If yes, please specify in the space below):

	Yes
	No

If YES, please specify any special accommodations or supports you may need during the week::

Financial Assistance with the Cost of the Camp

* Do you wish to be considered for financial assistance to cover the cost of the program?:

	Yes
	No

If YES, Please briefly explain your need for financial assistance.
(Tell us why you are requesting support and how attending this leadership institute will benefit you or your child. Response limit: 250–300 words):

Attach Transcript

Please attach a copy of your school transcript (unofficial or official):

7. AUTHORIZATION

* Student and Parent Commitment

I understand that the Summer Leadership Institute is a boarding-only camp, and I commit to participating fully from July 13–20, 2025.

I understand that the total cost is $320, and payment must be completed by 06/30/2025.

I commit to participating in all workshops, community activities, and spiritual opportunities offered during the Institute.

I agree to uphold the spirit of respect, trust, and leadership expected at the Institute.:

	Yes
	No

* I verify that all the information I have provided in this document is true to the best of my knowledge.:

	Yes
	No

* Signature (type name):

* Date:

I agree that this form may be electronically signed and agree that my typed signature is the same as a handwritten signature for the purposes of validity, enforceability, and admissibility.

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