"Catch The Spirit" of the 2006 Summer Alaska Points of Light Youth Leadership Institute June 16 (9:00 a.m.) - June 20 (4:00 p.m.), 2006 Carlquist Conference Center
High School Student Application (Please Print Clearly)
Name ________________________________Age_______ Date of Birth________
Home Address ________________________________________________________
City/Village _____________________ State _____Zip Code_______________
Home Telephone Number _____________________Home Fax _________________
E-mail_______________________________________________________________
School Grade (Fall) ___________________
School Address __________________________________________________
Parent/Guardian Name (please print) _______________________________
Parent/Guardian Signature __________________________________________
Adult Reference ________________Title __________ Signature_______________
Please respond to the following questions on the attached sheet of paper. Your answers should be no more than allowed in the space provided. Some need based financial aid is available for registration fees.
**Checks should be made out to: "Alaska PYLI"
____________Partial Financial aid requested
____________(how much $ aid are you requesting)
You may deliver or mail your completed application and registration fee ($ 125) to:
2006 Summer Alaska Points of Light Youth Leadership Institute
3220 East 40th Ave
Anchorage, Alaska 99508
You may also deliver completed applications to Prudential Real Estate offices in Anchorage, Eagle River or Wasilla. Applications are due ASAP and no later than June 1.
You will be notified of selection within 2 weeks of application.
