the application

Summer Youth Leadership Institute 1 Please return application by June 1st to: Sunrise Administration Office 12724 Smith Road Dade City, FL 33525 Phone: 352-­‐521-­‐3358 Fax: 352-­‐521-­‐3099 Cassandra: [email protected] Aubrey: [email protected] The Summer Youth Leadership Institute’s (SYLI) goal is to develop student leaders who will work with peers to visualize and create a community where all people are valued, honored, and respected. Students will be role models and leaders in preventing interpersonal violence in their schools and communities and acquire the skills needed for peer support, advocacy, and community action. Youth entering grades 9th - 12th in East Pasco are encouraged to apply.
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SYLI Application: 1. First, complete this document (SYLI Application) and return via email, fax, mail, or drop off at Sunrise Administration Office (12724 Smith Rd, Dade City) by June 1st. 2. This is a competitive process therefore suitable applicants will be contacted to schedule an interview date to further discuss their potential participation in the SYLI. We will be conducting interviews throughout the month of June. Please contact us if any accommodations are needed. 3. Those that are invited to attend will be required to complete a second packet that includes the Program Consent & Release Form, Media Release, Health History & Medical Release Form, Pool & Ropes Course Waiver. This too must be forwarded to the Sunrise Administrative office by July 1st. Applications that aren’t fully completed will not be considered. •
SYLI Program Fee: Once the participant is accepted into the program, the $250 registration fee is due by July 1st. There are limited scholarships available. Payment options are available; please contact us for more information. •
Parent Information Session: Parents are expected to attend one informational session. Sessions will be offered on Thursday, July 9th at 6:30pm and Saturday, July 11th at 1:30pm at the Sunrise Administration Office (12724 Smith Rd, Dade City). Sunrise staff will be there to give a brief presentation about the Summer Youth Leadership Institute, as well as pass out applications and answer any questions. Revised – 4/15/15 2 2015 Summer Youth Leadership Institute Application Community Sponsoring Agency: Sunrise Domestic Violence and Sexual Assault Center’s Prevention Program is hosting the Summer Youth Leadership Institute. Sunrise received a grant from the Center for Disease Control and Prevention (CDC) to work with youth in preventing violence in their community through education and awareness campaigns so they can then take action in making their community a safer place. Objectives: •
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Youth will be able to apply leadership skills of their own and aid in the development of others. Youth will be able to identify, analyze, and develop strategies to combat the root causes of violence. Youth will understand their role as upstanders and will be more engaged in taking action in their communities. Eligibility Requirements: •
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Available to attend the 5 days and 4 nights institute at Saint Leo from July 20th -­‐ July 24th Must be entering grades 9th through 12th in East Pasco. Must be committed to working towards ending violence and promoting safe communities. Must commit to one (1) year of active participation to the Youth Community Action Team. Personal Information Name: _________________________________________________ Gender: _____________ DOB: __________________ Self-­‐identified Race: __________________________________________ Address: ___________________________________________________________________________ ___________________________________________________________________________________ Student Phone #: _____________________ Student Email: __________________________________ Current Grade: ___________ School: _________________________________________________ Are you a returning SYLI Student? [ ] Yes [ ] No If yes, are you interested in co-­‐facilitating this year? [ ] Yes [ ] No Revised – 4/15/15 3 Short Response Questions: 1.) What motivates you to attend the Summer Youth Leadership Institute? 2.) Tell us how you will be an asset to the program (what experience, skills or perspective do you bring)? 4.) What are you interested in learning more about? (Check all that apply.) Racial Discrimination _______ LGBTQ+ Issues_______ Healthy Relationships ________ Teen Dating Violence _______ Bullying ______ Community Activism _________ Other ___________________________________________________________________________ 5.) In your opinion, what is violence? 6.) Where does violence come from? 7.) What can you do to end violence in your community? Revised – 4/15/15 4 8.) What can we do as a community to end violence? 9.) Additional comments or information that may be helpful in considering your application: 10.) How did you hear about us? (Check all that apply.) Friend ______ Family Member ______ Program at school ______ School teacher/ administrator ______ Community Organization ______ Website/ Social Media _______ Other ___________________________________________________ The applicant must sign the following statement upon agreement: Leadership Institute and if I am selected I will I understand the expectation of the Summer Youth devote the time and resources necessary to participate in project activities and to attend program events. I also agree to a one year commitment to the Youth Community Action Team, through Sunrise and/or my local high school. Student Name (Print)___________________________________________________________ Student Signature _________________________________________ Date ________________ Revised – 4/15/15