Love is Respect Leadership Program Application Form Community Solutions Solutions to Violence

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1 Love is Respect Leadership Program Division is currently seeking youth leaders from South Santa Clara County to participate in a four day academy Love is Respect Leadership Program built on driving change in their communities. We need passionate, energetic, hardworking, and driven youth to provide input, plan community outreach events, and create change in their communities. 4-Day Love is Respect Leadership Academy We want your input and your voices to be heard! Tell us what s up with teens in our community. Give your feedback in ways to improve outreach and prevention programming to other teens. We re looking for teens that are not afraid to speak out and commit themselves to an important cause they are passionate about. We are looking for teens who want to innovate and make things happen! Commitment All youth will be asked to commit four days in June to the Love is Respect Leadership Program. The program will be from Monday June 22 nd through Thursday June 25 th from 9:00 AM to 1:00 PM each day. Rewards! Youth who participate in the Love is Respect Leadership Program will receive gift cards for their participation. Plus your contribution will make a difference in your community. We are looking for youth who feel they have something to say! If you want to build a healthier community, then you should apply! Must Haves Youth must be between the ages of Youth must be in good standing with their schools and maintain at least 2.0 grade average (must have a signature of your school guidance counselor to sign off on your application- see page 4). Willing to speak your mind in a group setting and share creative ideas. Be confident, passionate, and committed to sharing your opinions and expertise. How to Apply Fill out the attached application, including the questions and then submit them online to or drop off at our Gilroy/Morgan Hill office attention to Erica Elliott. All applications must completed filled out, included parent signature and teacher recommendation form. All applications are due by June 17, 2015 at 5:00 PM.

2 El Programa de Liderazgo Amor es Respeto La División de Soluciones a la Violencia de Community Solutions actualmente busca de 15 a 20 líderes jóvenes del sur del Condado Santa Clara para participar en el Programa de Liderazgo Amor es Respeto creado para dirigir cambios en sus comunidades. Necesitamos jóvenes apasionados, energéticos, trabajadores, y motivados para aportar ideas, planear eventos de alcance y compromiso a la comunidad y crear cambios en sus comunidades. Programa de Liderazgo Amor es Respeto Deseamos que se escuchen sus ideas y sus voces! Díganos que está pasando con la juventud en nuestra comunidad. Denos sus pensamientos en que manera podemos mejorar nuestro alcance a la comunidad y mejorar los programas de prevención para otros jóvenes. Buscamos jóvenes que no tengan miedo a hablar y comprometerse a una causa importante que les apasione. Buscamos jóvenes que quieran innovar y hacer que sucedan cosas! Compromiso Se pedirá a todos los jóvenes a cometer cuatro días de Junio para el Programa de Liderazgo Amor es Respeto. El programa será de lunes 22 de junio a jueves 25 de junio de 9:00 AM a 1:00 PM todos los días. Recompensas! Los jóvenes que participen en el Programa de Liderazgo Amor es Respeto recibirán tarjetas de regalo. Además, su contribución hará una diferencia en su comunidad. Buscamos jóvenes que sientan que tienen algo que decir! Si usted desea crear una comunidad más sana, usted debe aplicar Nececidades El/la joven debe tener entre 14 y 17 años. El/la joven debe estar bien en su escuela y mantener al menos un 2.0 grado promedio (debe obtener la firma de un consejero guía escolar en su aplicación vea página 4). Debe estar dispuesto/a decir lo que tiene en mente y compartir ideas creativas delante de grupos. Tener confianza en si mismo, ser apasionado, y comprometerse a compartir sus opiniones y experiencia. Cómo Aplicar Complete la aplicación adjunta, incluyendo las preguntas y envíe su aplicación por internet a o llévela a nuestra oficina de Gilroy o Morgan Hill. Las aplicaciones deben estar completas, incluyendo la firma de padre o madre y la forma de recomendación de su maestro/a..toda aplicación debe entregarse a más tardar el 17 de junio, 2015 a las 5:00 PM.

3 Love is Respect Leadership Program Application Form Applications can be found at online at Please or drop off completed applications by June 17, 2015 to: or Fax: or Drop off with attention to Erica Elliott at either of our offices: 9015 Murray Ave. Suite Church St. Suite 103 Gilroy, CA Morgan Hill, CA For any questions please feel free to or call Erica Elliott at or Application Information Name: Home # Cell # Address (including city): Current Grade Date of Birth: Name of Parent or Guardian Home # Cell # Parent Signature Date Do you speak, read, or write in any other language? List any other activities you are involved in outside of school. Such as sports, hobbies, community services, responsibilities, or other activities you choose to list. Please list at least two references. Name of reference Cell # Years known: Name of reference Cell # Years known:

4 Please answer the following questions. Use the space below to answer each question. If you need additional space please use extra sheet of paper. 1. We want to know why you want to be involved. What motivates you to want to participate in this leadership academy? 2. Please describe what a healthy relationship looks like and what an unhealthy relationship looks like.

5 Parent/Legal Guardian Permission I have read and understood all of the above information. I understand that by signing in the below areas I am allowing my teen to be involved with the Youth Leadership Academy. I will support the youth in attending all meetings and academy dates. I support my youth s decision in participating in the Youth Leadership Academy. I have read and understood the conditions listed above. Student s Name (print name): Student s Signature: Date: Parent or Legal Guardian s Name (print name): Parent or Legal Guardian s Signature: Date: Permiso de la escuela El estudiante entregando esta solicitud está en regla con la escuela. Regularmente asiste a la escuela y mantiene un promedio escolar de 2.0. Apoyo al joven en participar en la academia de liderazgo juvenil. Este estudiante es un excelente candidato/a para la academia de liderazgo juvenil. Estoy de acuerdo con esta declaración Firma del estudiante: Firma del estudiante Fecha Nombre de consejero Número telefónico Firma de consejero Fecha

6 Teacher Recommendation Form Love is Respect Leadership Program Love is Respect Leadership Program is a youth program established by Division to engage individuals that are who are passionate, hardworking, and driven. The participating youth would provide input about outreach and prevention programming to other teens, plan community outreach events, and create change in their communities. The student listed below has applied to participate in the Love is Respect Leadership Program. Please assist us by completing this form with your recommendation and comment. Student s Name Please check in the appropriate column the factors for which you have adequate information for appraisal. 1. Ability to follow instructions 2. Social skills (gets along well/respect for others) 3. Demonstrates dependability 4. Self-motivated 5. Demonstrates responsibility (directs energies toward tasks) 6. Demonstrates enthusiasm in performing assigned tasks 7. Strives for excellence 8. Punctual 9. Mentally alert (organization skills/problem-solving skills) 10. Demonstrates proper etiquette and manners 11. Personal appearance/grooming 12. Demonstrates integrity/honesty 13. Demonstrates optimism and self-respect 14. Capacity to try new ideas and increase knowledge 15. Attitude toward constructive criticism 16. Ability to adapt to change 17. Cooperates with others 18. Communication skills 19. Demonstrates attention to detail 20. Ability to set realistic goals GOOD FAIR POOR Do you recommend this applicant for the Love is Respect Leadership Program? Yes No Additional Comments: Staff Signature Date Print Name School

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