Application Form – Fireside

IGNITE Youth Leadership Program site / location you are applying to:

Student First Name

Student Last Name

Student Gender

Student Birth Date

Street Address (Street, city, state, zip)

Student Cell Number (best number we can reach you at)

Student School (If you are homeschooled, please state below and name the program you’re with if applicable. Ex: 10:10 Academy / Cambrillo Point / Springs Charter)

Student’s Grade (what grade will you be entering into in the Fall 2024/Spring 2025 school year)

Have you participated in a Kid Works and/or Avenue Church program before?

Yes No Other

If "Yes" or “Other” to question 9, please name the youth group, sport, or other after school program / activity you have participated in.

Student’s Race

White or Caucasian: British, French, German, etc. Black: Kenyan, Nigerian, Somalian, biracial, etc. American Indian or Alaska Native: Iroquois, Cherokee, Navajo, Inida, etc. Latin or Hispanic: Cuban, Mexican, Puerto Rican, etc. Asian: Japanese, Korean, Chinese, Cambodian, etc. Pacific Islander or Hawaiian: Samoan, Tongan, Maori, Tahitian, etc. Other

If Other, please specify

Student’s Ethnicity

If Other, please specify

Student Medical Details (food allergies, medications, asthma, vertigo, etc.)

Essay (Upload required)

Please write a half-page, 2–3 paragraph essay on why you want to be a part of the Ignite Youth Leadership Program. Please include why you think you would be a good leader and what leadership skills you would bring to the team. Please also include any previous experience coaching / mentoring kids, siblings, cousins, etc. Please upload your essay below.

Photo or copy of one form of ID (state issued, school ID, etc.)

Photo or copy of last semester grades (Fall 2023)

Please provide the name (First and Last) of one person for recommendation (e.g. a teacher, Kid Works or church staff member, former coach, youth pastor, etc.)

Recommender’s relationship to you (e.g. they were your teacher, youth group leader, coach, etc.)

Recommender’s position/job and institution of employment

Recommender’s email and phone number

Date

Parent/Guardian Name (will be used as emergency contact)

Parent/Guardian Phone Number

Parent/Guardian Email

Parent/Guardian Home Address

Other

Electronic Parent Signature

After you have completed the application, you will be contacted for an in-person interview. Please be on the lookout for an email and/or phone call / text message within the next 7 days. It is your responsibility to respond to our request for an interview. If we do not hear from you after 7 days, we will move forward with other applicants and assume you’ve withdrawn from the process. Please also come prepared and dressed appropriately when your interview is scheduled (if you’re not sure what that is ask a teacher or your mom or dad). The IGNITE Youth Leadership Program is not your typical after-school program. We are a program where the student applies, engages, and excels. In other words, you must be interested to proceed (not being signed up by mom or dad). We call students higher, and it starts with this process.

We look forward to meeting you and we wish you the best. God Bless!

— The IGNITE YLP TEAM