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Online Student Application Form


This student is recommended by:(Business/Person/Organization)


Three Step Application Form


1. To be completed by the student and parent or gaurdian


Fill out parts 1 and 2 and please submit electronically by February 12, 2010, for processing. The counselor from your high school will be contacted to receive your scores in Part 3. (Address, phone, and e-mail will be included in a participant's directory)


First Name: Last Name: Gender:
Home Address: City: State: Zip: Parents or Guardians Names: Home Phone (555-555-5555): Applicant's Cell Phone: Applicant's E-mail Address: Date of Birth (DD/MM/YYYY): Junior:
High School Name: High School City: Name of Local Newspaper: Counselor/Teacher's Name to Complete Part 3: Location:
T-shirt (Run Large) Choose One:




I understand that if I am selected to attend YBA, I will submit a nonrefundable $150 registration fee to the YBA office. (Do not send money with this form.) I have read and agree to abide by the program safety guidelines. I understand this program is challenging as well as fun. I also understand my parents and I will need to sign a hard copy which states we both understand the rules of YBA.


2. To be completed by student:


Please explain in one paragraph why you would like to attend YBA. This statement will be used in selecting participants. If left blank, applicant will not be considered.



Scholastic and extracurricular activities (Indicate activity with number of years involvement):

Step three will be mailed to the provided teacher, guidance counselor, or principal.

Students will need to submit a school picture if selected to be used in press releases. This information will come in the mail. Thank you!