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Untitled Document

RPCA Future Leaders

INSTRUCTIONS
1. Complete the entire form
2. Type or print all the information
3. Limit answers to the space available
4. Form must be signed by both the nominee & a parent

CRITERIA
The RPCA Future Leaders is committed to providing leadership development and training to a group of motivated students who represent a diversity of racial, ethnic, and socioeconomic groups in the City of Alexandria.

Interested nominees should:
• Demonstrate their leadership potential for community trusteeship
• Exhibit interest in community service
• Commit to FULL PARTICIPATION AND ATTENDANCE in all RPCA Future Leaders programs. (You must attend 80% of our sessions to graduate.)
• Maintain satisfactory academic, attendance, and citizenship records

STUDENT RECOMMENDATION
A student recommendation needs to be completed by someone from the nominating agency.

ATTENDANCE
Due to a limited number of positions in the class, a commitment to the program and full attendance at each activity are expected. If you cannot make a full commitment to the program, please do not apply.

(The City of Alexandria RPCA Future Leaders does not discriminate on the basis of gender, race, religion, or national origin.)

1. Teen's Full Given Name: *This question is required.

2. Preferred Name (for name tags): *This question is required.

3. Teen's Mobile Number: *This question is required. This question requires a valid number format.

4. Teen's Email: *This question is required. This question requires a valid email address.

5. Home Phone Number This question requires a valid number format.

6. Complete Address *This question is required.

Street Address
City
State
Zip Code

7. Gender: *This question is required.

Male
Female
Non-binary

8. Birthday (MM/DD/YYYY): *This question is required.

9. Age: *This question is required. This question requires a valid number format.

10. Race: *This question is required.

11. School Presently Attending: *This question is required.

12. Grade: *This question is required.

13. Shirt Size: *This question is required.

14. Referring Recreation Center *This question is required.

15. Allergies *This question is required.