Teen Leadership Institute Application Form

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YWCA Greater Pittsburgh Teen Leadership Institue

Please complete the form below.

* = information required

Teen Leadership Institute Application

* Date of birth:
* Gender

* First Name:
* Last Name:
* Address1:
Address 2:
* City:
* State:
* Zip Code:
* Phone Number:
* E-mail Address:
* Parent/Guardian's First Name:
* Parent/Guardian's Last Name:
* Parent/Guardian's Work Phone:
Parent/Guardian's E-mail Address:
* Emergency Contact Name:
* Emergency Contact Phone Number 1:
* Emergency Contact Phone Number 2:
* How did you hear about the Teen Leadership Institute?

If other, please explain:
If you a returning student, please select previous years of participation in the program.

Please select your favorite subjects from this list. (please check all that apply- hold down the CTRL key to select more than one):

* Do you plan to attend college?	Yes No
What do you want to study in college?

Where do you want to attend college?

* Name of last school you attended:
* Address of last school you attended:
* Last grade completed:

* Your ethnic background - please select the group you most closely identify with: (select one)

* How is your health? (select one)

Are you currently taking any medications? If so, please list.
List any medical conditions or disabilities:
* List all interests, extracurricular activities and hobbies:

* Please write a brief narrative about yourself. Include long and short term career goals.

Building your future starts with building a foundation.

Control your destiny by becoming a leader.

Come and join us at the YWCA Greater Pittsburgh Teen Leadership Institute.

Upcoming Events

Friday, September 24, 2010

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Retrospective on Women, Then & Now

The YWCA will feature renowned women's rights activist Gloria Steinem as our keynote speaker during an upcoming luncheon event at The Omni William Penn Hotel. Click here to register online.

Saturday, October 9, 2010

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11th Annual Pink Ribbon Luncheon and Fashion Show

In its 11^th year, the YWCA’s signature breast health awareness event educates women about breast cancer and celebrates breast cancer survivors.

October 17-22, 2010

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15^th Annual YWCA Week Without Violence

The YWCA Greater Pittsburgh's 15th annual Week Without Violence focuses attention on practical, sustainable non-violent alternatives through a week-long series of events.

See All Events