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2012 Application

Please fill out the form below to apply for a 2012 Youth Policy Summit program. You cannot save and return to this form as you enter your information, please have all necessary documents ready when completing the application. Answer all questions as completely and truthfully as possible to ensure that your application can be processed in a timely manner. If you have any issues with your online application, please contact a Program Manager. You will receive an automatic email response once your application has been submitted, and will find out whether you have been accepted into the program you applied for within 5-7 business days.

  • Personal Information

  • First Name
  • Last Name
  • Address
  • Phone (home)
  • Phone (cell)
  • Email
  • Date of Birth (use this format: 11/11/2011)
  • Parent/Guardian Name
  • Parent/Guardian Phone
  • Parent/Guardian Email
  • Emergency Contact
  • Emergency Phone
  • School
  • Grade Level in Fall 2012
  • YPS Program Applying For

  • Additional Information

  • 1. The Keystone Center values student diversity as one of the essential elements of the Youth Policy Summit program. Please indicate racial/ethnic background by checking all that apply. (Press Ctrl to select more than one.)
  • 2. Please indicate your gender.
  • 3. Though the majority of students attend YPS as individuals, we also welcome you to attend with a friend. If you are applying with a friend (or friends) and would like to request to room together, please note your friend’s name here. YPS staff will work hard to accommodate everyone, although room requests are not guaranteed.
  • 4. We offer a discount to those who refer a friend. If a friend who is signed up for YPS referred you, please list their name here*:
  • *Please note that due to subsidized pricing, discounts are not available for the NCSSSMST program.
    5. Are you applying for a YPS scholarship? If not, please skip to Personal Statement.

  • Scholarship Application

     

    YPS Scholarships are awarded on a need-basis. Please answer all questions fully to be considered for a scholarship. Scholarship funds are limited and awarded on a first-come, first-serve basis, so we encourage you to apply early. All information is strictly confidential.

  • 1. How many people are in your household? Adults?
  • Children?
  • 2. Combined annual income of family members, as listed on your 2010 Form 1040:
  • 3. Please note on an attached document any special circumstances, projected loss of income, or high household expenses to help us make the most informed decision about your scholarship needs.

  • Personal Statement

     

    On an attached document, please answer ONE of the following questions in 500 words or less.

    1. Why do you want to participate in a Youth Policy Summit program? What about the topic or programappeals to you and why will you personally benefit from attending a Summit?
    2. What makes an effective leader? Who is a leader that you respect, and how have you demonstrated leadership qualities?
    3. Youth Policy Summit is designed to give students a voice on issues of public interest and importance. How are you involved with policies and decisions within your home, school, community, state and/or nation?
  • Upload Personal Statement

  • For Our Records

  • How did you hear about YPS?

  • Consent

     

    Please read parts A-C carefully and sign below.

    A. All information on this form is true and complete to the best of my (our) knowledge. If the validity of my information is in doubt, I agree to provide proof of the information on this form.

    B. I consent to have any information submitted in the admissions and financial aid process used in reports to donors and in published Keystone Center program materials. I understand that The Keystone Center will never use my name or identifying data without further permission.

    C. If accepted to attend YPS, I consent to honor all program rules and regulations and to participate fully in all program sessions.

  • Signature
  • Date
  • Parent or Guardian Signature
  • Date
  • id