Submit completed form to: youthaviators1@gmail.com |     www.youthaviators.org   

     

Section 1: Student Information

  

Full Name:

  

Date of Birth:

  

Age: Gender: Race/Ethnicity:

  

Address:

  

Neighborhood: City: Zip:

  

Phone: Email:

  

School: Grade: GPA:

     

Section 2: Parent / Guardian Information

  

Parent/Guardian Name:

  

Relationship to Student:

  

Parent/Guardian Phone:

  

Parent/Guardian Email:

  

Emergency Contact Name:

  

Phone:

     

Section 3: Background & Interests

  

How did you hear about Youth Aviators?      School      Social Media      Friend      Event      Other:        

  

Why are you interested in aviation and this program?

     

Have you participated in aviation, STEM, or youth programs before?      Yes      No   

  

If yes, please describe:

     

Career goals after high school:

     

Hobbies or extracurriculars:

        

Section 4: Academic & Community Background

  

School Principal Name:

  

Email:

  

School’s Parent Coordinator (optional):

  

Parent Coordinator Email (optional):

  

Volunteer/Community Service:      Yes      No   

  

If yes, please describe:

        

Section 5: Consent & Signature

  

By signing below, I certify that all information above is accurate to the best of my knowledge.

  

Student Signature: Date:

  

Parent/Guardian Signature: Date:

     

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