Applicant Name First Last Name of School District(Include if private, homeschooling, etc...)Applicant Email Parent Email (Please provide an email that you check often, acceptance will be sent to this email address.)Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Home PhoneParent Cell PhonePlease answer the 4 questions below. You must answer each question. If you leave a question blank, your application will be considered incomplete and will be ineligible for consideration.1. Please tell us a little about yourself. Include any special interests/skills, hobbies, jobs, volunteering you may have done, any groups/teams you are a part of (whether in school or out of school).2. Who is someone you see as a leader and why? (It can be someone in your life an/or historical figure.)3. Describe a time when you had to overcome a challenge and/or obstacle in your life.4. Please tell us why you want to join Junior Leadership Orange.A School Guidance Counselor MUST be aware that you are applying for the Junior Leadership Orange Program. We must be able to reach your guidance counselor regarding acceptance into the program.Name of Guidance CounselorEmail of Guidance CounselorPhone Number of Guidance CounselorHave your parent read this portion and then both sign below: I am aware that my child is applying for the Junior Leadership Orange Program. If selected, I understand that we must be in attendance at a Family Informational Session that will be scheduled over the summer months (you will be given two dates and times to chose from.) In order to participate, my child will miss SEVEN days of school over the course of a year and any work missed while taking part in this program must be made up. This is a participatory program and youth are expected to be ACTIVE participants, taking part in conversations, interactive games etc… The Junior Leadership Orange Program is primarily funded through donations received from private donors, community groups and business leaders. While there is NO COST to participate in the program, we do ask the current JLO Class to participate in one annual fundraiser. Participation not only helps to raise additional funds, it also reinforces what an integral part the current class continues to play in the success of future Junior Leadership Orange classes. Any special needs, allergies or medical concerns must be communicated at the time of registration. If your child has special dietary needs, you must provide their own meals and snacks. If your child needs medication on hand during sessions, please provide that medication with a dated & signed Physician’s note. Provided medication will be secured in a locked box and transported with your child throughout the day for use as needed or designated. Note: Youth must be able to self-administer medication.Parent's Signature*Please enter your full nameDate Date Format: MM slash DD slash YYYY Applicant's Signature*Please enter the applicant's full nameDate Date Format: MM slash DD slash YYYY This iframe contains the logic required to handle Ajax powered Gravity Forms.
