2016 Youth Leadership Institute Nominator Form
2016 Youth Leadership Institute Nominator Form About the Youth Leadership Institute: The Youth Leadership Institute (YLI) is a four-day, overnight college empowerment conference for outstanding Latino high school juniors designed to give students the practical tools they need to set a course for academic and career success. Cost: The program is free of charge. HSF also provides regional transportation for some students, when available. Locations and Dates: June 23 - 26 – University of California, Irvine (CA) June 30 - July 3 – University of Pennsylvania (PA) July 28 - 31 – The University of Chicago (IL) Student Qualifications: High School Class of 2017 (current high school juniors) 3.0 GPA or above on a 4.0 scale Identify as being of Hispanic heritage Nomination Process: The Hispanic Scholarship Fund is seeking outstanding junior applicants to participate in the 2016 YLI programs. Please nominate up to 5 male and 5 female candidates who display leadership in your campus community and maintain at least a 3.0 cumulative GPA. Students may be nominated by a parent, principal, guidance counselor, teacher or other professional in their local community. PLEASE NOTE: Students DO NOT have to be nominated to apply and your nomination DOES NOT guarantee the acceptance of your candidates. The forms you will need to nominate are provided below. Step 1: Complete the Nominator Information form. Step 2: Complete the Nominee List by entering the full information for each of your qualified candidates, as designated, in the tables below. Step 3: Return the Nominator Information form electronically to Michelle Sandoval at [email protected], or via fax at 310.349.3328, before Friday, April 1, 2016. Step 4: Each of your candidates will be contacted and instructed to complete his/her YLI application before the deadline of Friday, April 15, 2016.
Nominator Information Nominator Name (Required) First Name:
Middle Initial:
Last Name:
Occupation or Title (Required):
Employer (Required):
Address or P.O. Box (Required):
City:
State:
Zip Code:
E-mail Address (Required):
Alternate E-mail Address:
Telephone Number (Required):
Alternate Telephone Number:
Nominator’s Relationship to Nominees (Required) School Principal Teacher Guidance Counselor Other Professional:_______________________
Nominee Eligibility Information Does each nominee have cumulative GPA of 3.0 or above on a scale of 4.0? Yes No Will your nominees be graduates in the class of 2016? Yes No Do the nominees identify as being of Hispanic heritage? Yes No
Nominee List Male Student Nominee Information First Name
Last Name
Email
Phone Number
Grade Level
GPA
Email
Phone Number
Grade Level
GPA
1. 2. 3. 4. 5. Female Student Nominee Information First Name
1. 2. 3. 4. 5.
Last Name
Nominator Information Nominator Name (Required) First Name:
Middle Initial:
Last Name:
Occupation or Title (Required):
Employer (Required):
Address or P.O. Box (Required):
City:
State:
Zip Code:
E-mail Address (Required):
Alternate E-mail Address:
Telephone Number (Required):
Alternate Telephone Number:
Nominator’s Relationship to Nominees (Required) School Principal Teacher Guidance Counselor Other Professional:_______________________
Nominee Eligibility Information Does each nominee have cumulative GPA of 3.0 or above on a scale of 4.0? Yes No Will your nominees be graduates in the class of 2016? Yes No Do the nominees identify as being of Hispanic heritage? Yes No
Nominee List Male Student Nominee Information First Name
Last Name
Phone Number
Grade Level
GPA
Phone Number
Grade Level
GPA
1. 2. 3. 4. 5. Female Student Nominee Information First Name
1. 2. 3. 4. 5.
Last Name
