Name: * Parent(s) or Guardian(s) Name: * Address: * City, State, Zip: * Phone Number: * Email Address: * T-Shirt Size: * S M L XL 2XL High School: * Brown County Central Griggsville-Perry Liberty Meredosia-Chambersburg Payson Seymour Quincy Christian Quincy Notre Dame Quincy Senior High Rushville/Industry Southeastern Unity Warsaw Grade: * High School Sophomore High School Junior Date of Birth: * Age: * How did you hear about the program? * 1. Personal Achievement (Include both School and Non-School Activities) Please list your participation in school-related activities, community involvement, religious, jobs, or other non-school related organizations. Include the organization, number of years, special awards, recognition's, accomplishments/remarks. * 2. What are your plans after high school? * What moment in American history do you wish you had been a part of and what would you have contributed? * 4. Cooperatives can provide any needed service such as electric, telephone, water, food, insurance, etc. Explain a benefit of being a cooperative member. * 5. If you win the Youth to Washington program, you may be asked to help promote the program to fellow classmates next year. Describe one way you would promote the program. Be creative! * 6. Why are you applying for the Youth Tour Program? * By completing and submitting this application, I verify my eligibility to attend Youth Day in Springfield. If chosen to participate as a Youth Day participant, I commit to the trip to Springfield. I also understand that if I should be selected as one of the winners of this contest, I would take the all-expense paid tour of Washington, D.C. Box must be checked by student completing application. This application and agreement were completed by (please provide name and date): I hereby give my consent for the above named student to participate in the Youth to Washington contest and take the trip the Washington, D.C. if selected as a winner. Box must be checked by the parent or guardian of the above student. Parent or guardian's name and date (Must be completed by parent or guardian giving consent): * reCAPTCHA If you are human, leave this field blank.