Name*	Last Name                  First Name ,
Age*
Home Address*
City*
State*
Zip*
Home Phone*
E-mail*
Parent(s)/Guardian(s) name(s)*
School* (if attending)
Year of Graduation*
How did you hear about YPI? (friends, parents, other adult, radio, website, newspaper, etc.).*

Gender	Male Female
Race	Caucasian African American Asian Hispanic Native American Middle Eastern Other

1. What does “giving” mean to you? Describe a time that someone has “given” to you and the effect it had on you.*

2. What issue facing teens is most important to you?*

3. Why is it important to the community that this issue be addressed?*

4. What would you like to get out of your participation in YPI?*

5. What is something others have told you is a unique talent you possess? Please give an example of how you used that talent productively.*

6. Please list activities/organizations you are involved in (hobbies, school, community, church, groups, work, etc.):*

7. What is your favorite school subject and what about it do you find most interesting? *

8. Where do you want to be 10 years from now? In other words, what are your goals and plans?*

During the selection process we may wish to contact two people who know you. Please provide the name and phone number of:* o 1 person you consider to be a good friend who wouldn’t mind telling us more about you. o 1 adult who can speak to the way you conduct yourself—it could be a teacher, employer, youth group leader, etc.

    Follow-up interviews may be requested.