SuperSTARS Leadership Academy
Application 2016 -2017
Thank you for your interest in PowerPlayNYC's SuperSTARS Leadership Academy.
To apply, first please make sure you've downloaded
the following documents in order to submit below:
1)
health form (with liability and media release included),
2)
participant & parent agreement
3)
and reference form
Next, please complete the application below and
submit documents in the appropriate spaces.
*Please note -- you will also need to submit a copy of the student's high school transcript.
Name
Street Address
Email
Home phone:
City:
State:
Cell phone:
School:
Date of Birth:
Ethnicity:
Hispanic/Latino
White
Asian
Native American
African
Other
Black/African-American
Parent/Guardian Phone 1:
Parent/Guardian Phone 2:
Name of Parent(s)/Guardian(s):
Parent/Guardian Email 1:
Parent/Guardian Email 2:
Emergency Contact:
What is your Parents/Guardians highest completed level of education?
Some High School
High School Graduate/GED
Some college
Associates Degree
Bachelors Degree
Graduate Degree
I don't know
Why are you interested in participating in PowerPlay’s SuperSTARS Leadership Academy and what do you hope to gain from it?
What are two or three of your favorite things to do? And your least favorite?
Describe for us a tough situation you’ve faced, at school, with a peer or at home, and how you dealt with it. Did you learn something from the experience and how might you share that with others?
Please list any extracurricular activities you participate in (such as after-school, YMCA programs, sports, religious, etc.). If you have not been involved with an extracurricular activity, what kind of program would you want to be a part of? Why?
Tell us two or three things you’d like to get better at--either something you’re good at and would love to improve or something you really need to work on that’s important to you.
Did we miss anything? Share it here:
Please upload High School transcript(pdf or doc/x format, 100KB limit).
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Please upload our reference form -- this can be written by a coach or teacher -- just not a family member (pdf or doc/x format, 100KB limit).
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Please upload signed Youth Commitment Agreement(pdf or doc/x format, 100KB limit).
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Please upload the Health Information Form (including the Liability and Media Release) (pdf or doc/x format, 100KB limit).
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How did you hear about PowerPlay's SuperSTAR Leadership Academy?
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