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Balance Application

Leadership Academy of Madison County is committed to providing leadership development and training to a group of motivated individuals. For this reason we have designed a program to help seniors prepare for a successful transition as they prepare to graduate and develop a sense of "balance" as they move forward in their life's journey.

Interested nominees should:

  • Demonstrate their leadership potential

  • Exhibit an interest in developing and growing as a person

  • Committee to FULL PARTICIPATION AND ATTENCANCE in all Balance activities

  • Maintain satisfactory academic, attendance and citizenship records

  • $300 Tuition paid in full by 09/30/2023 

Application deadline is August 1, 2023.

If there are any parts that you have forgotten, the field turns red. Once filled out and submitted, the form simply clears all your answers, and we will email you a confirmation.

Personal Information

What Is Your Gender

Gender*

LAMC does not discriminate on the basis of gender, race, religion or national origin.

T-Shirt Size *

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Organizations And Activities

Please list any school, volunteer, religious, social, athletic or other activities in which you have participated. Explain what role you play in these organizations.

Work Experience

Do you currently have a job *

If Yes, where do you work

Will your employer make reasonable accommodations

so you can participate *

If no, please explain

List any job experience, full-time or part-time, and briefly explain.

Parent Information
Personal Profile

Explain a time when you've needed to use your leadership skills.*

As an emerging leader, what leadership skills and traits would you like to improve on? *

What do you hope to gain to help you with the transition into adulthood from this experience? *

How will participating in this program help you grow and succeed in college or your

career? *

Why do you want to

participate in Balance? *

If you could improve one thing in our community what would it be, and why? *

What career field are you interested in learning more about?

Program Agreement

Balance Program Agreement *

  • I understand that attendance at all Balance sessions is expected for graduation.

  • My behavior and participation will always reflect positively on Balance and my sponsoring agency.

  • Balance is a drug and alcohol free program, and I will abide by those standards during all Balance events.

  • I realize that I am a representative of all youth and I will at all times represent them honorably.

  • I authorize Balance to take appropriate measures if I cannot fulfill this agreement.
     

Balance Program Agreement

Medical/General Liability Release *
I understand that my parent (or guardian) will be required to sign a medical release form prior to my participation in Balance.

Liability Release

Photography Release *
Leadership Academy of Madison County (LAMC) staff, volunteers, and representatives routinely document activities associated with the Academy through photography, videography, audio recordings and other forms of media. I recognize that this media will be used in LAMC presentations, reports, and promotional materials, including on the LAMC/YLA/Balance website and social media sites. I hereby waive my child’s rights to privacy with respect to the use or release of the above-mentioned media. I further understand that no royalty fee or compensation of any character shall become payable to me or my child by the Leadership Academy of Madison County by reason of such use. I hereby release Leadership Academy of Madison County and its staff, volunteers, and representatives from any liability in its use or the use by others. I agree that the Leadership Academy of Madison County may use such photographs of my child with or without my child’s name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. 

Liability Release

I have read and agree to the Selection Criteria and Applicant Commitment information. *

I have read and agree

If there are any parts that you have forgotten, the field turns red. Once filled out and submitted, the form simply clears all your answers, and we will email you a confirmation.

An error occurred. Please be sure all required fields are filled out correctly

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