FBI NATIONAL ACADEMY ASSOCIATES
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1 FBI NATIONAL ACADEMY ASSOCIATES 2016 YOUTH LEADERSHIP PROGRAM APPLICATION APPLICANT Name: (M/F) Age (DOB) Address: City: State: Zip Code: Telephone: Area Code ( ) - Cell Phone: ( ) - School: City: State: Employment: City: State: PARENT OR LEGAL GUARDIAN Name(s) of Parent(s) or Legal Guardian(s): Address: City: State: Telephone: Area Code ( ) - Cell Phone: ( ) - Name of Employer: Telephone: ( ) - Please list any Sports, School Clubs/Activities/Offices, Hobbies, and Special Interests/Talents What do you expect to gain from attending the Youth Leadership Program? Applicant s Signature: Date: Print Name: 2016 YLP Form 03
2 ATTACH RECENT PHOTO HERE This MUST be completed by candidate: Candidate s Sponsor: Session: Member #: PARENTAL CONSENT I UNDERSTAND MY SON/DAUGHTER WILL BE ATTENDING THE YOUTH LEADERSHIP PROGRAM AND EXCEPT WHILE TRAVELING ON A COMMERCIAL AIRLINE OR CONVEYANCE, WILL BE UNDER THE CONSTANT SUPERVISION OF A MEMBER OF THE FBINAA, Inc. WITH THIS UNDERSTANDING I APPROVE OF HIS/HER PARTICIPATION IN THIS PROGRAM. I FURTHER CERTIFY THAT HE/SHE IS MEDICALLY AND PHYSICALLY FIT TO PARTICIPATE IN ALL PROGRAM REQUIREMENTS. I UNDERSTAND THAT SHOULD MY SON/DAUGHTER LEAVE THE PROGRAM PRIOR TO COMPLETION I AM RESPONSIBLE FOR COSTS INCURRED BY THE SPONSORING FBINAA CHAPTER AT THEIR DISCRETION. Parental/Guardian Signature: Date: Print Name: Emergency Telephone Number: ( ) - (IMMEDIATE RESPONSE) Emergency Contact Name: List any physical limitations or medical problems of the son/daughter that staff must be aware of: A Medical Release Form (YLP Form 04) will be required prior to acceptance to the program. To be completed by Sponsoring FBINAA, Inc. Chapter Return Completed Application to: President: FBINAA Chapter: Street Address: City: State: Zip Code: FBINAA Chapter Submission Deadline: April 22, 2016 Applications received after this date will not be accepted YLP Form 03
3 FBI NATIONAL ACADEMY ASSOCIATES 2016 Youth Leadership Program MEDICAL INFORMATION/RELEASE FORM Required Information Name DOB SS# Address City State Zip Home Phone Cell Phone FBINAA Sponsoring Chapter (PLEASE ANSWER ALL QUESTIONS. IF NOT APPLICABLE INDICATE AS SUCH.) List any impairment: mobility, sight, hearing or speech etc. If so would any special assistance be required? List any medical problems emergency personnel should be aware of and any medications the student is presently taking: List all allergies: In the event that he/she should be unable to communicate with medical personnel, list specific information they would need to know about medical history and ailments: EMERGENCY NOTIFICATIONS In case of emergency, please notify the following: Name Relationship Phone Name Relationship Phone In the event of any sudden illness or medical emergency occurring to my son/daughter, by my signature I expressly grant the FBI/FBINAA full authority to 1) release the above medical information to emergency or medical personnel and 2) perform any necessary medical emergency treatment to my son/daughter after reasonably diligent efforts to notify me have failed. I will personally fill out the File of Life packet and I will instruct my son/daughter to carry it at all times while traveling to, from and at the program. Signature Relationship Date STATE OF COUNTY OF, to-wit: The foregoing was acknowledged before me this day of, 2016, By. Notary Public My Commission Expires: 2016 YLP Form 04 PHYSICIAN CERTIFICATION I have read the Youth Leadership program syllabus and activity requirements. I have examined and certify that he/she is physically fit to meet ALL of the activities including the 4.25 mile USMC Endurance/Stamina Course (Yellow Brick Road). Physician Signature DEA/ID # Physicians Name Phone *Return this form with the Registration Packet *
4 FBI NATIONAL ACADEMY ASSOCIATES 2016 Youth Leadership Program ESSAY What is Leadership (Use other side if necessary) Signature: Print Name: 2016 YLP Form 05
5 Day 1 Saturday, June 13, :00 AM - 4:30 PM Student Pick-up ALL Reagan Airport YLP Uniform for Instructors 5:00 pm Depart Reagan Airport to Academy ALL Reagan Airport 6:00 PM - Arrive at DEA Dormitory Check-in & Drop luggage ALL Dormitory 6:30 PM - 7:00 PM Dinner ALL Cafeteria 7:00 PM - 8:30 PM Group Assignments & Orientation ALL Cafeteria 8:30 PM - 9:00 PM Counselor Groups ALL TBD 9:00 PM - 9:30 PM Un-Pack and Set up Rooms Dormitory 9:30 PM Lights Out
6 Day 2 Sunday, June 14, :30 AM - 7:00 AM Wake-up/PT ALL Outside Gym Clothing 7:00 AM - 8:00 AM Breakfast ALL Cafeteria YLP Uniform 8:00 AM 8:45 AM Briefing ALL Classroom YLP Uniform 8:45 AM 9:00 AM Greeting by Mr. Cappetta ALL Classroom YLP Uniform 9:00 AM 12:00 PM Law Enforcement Organizations Mr. Foster Classroom YLP Uniform 12:00 PM - 1:00 PM Lunch Cafeteria YLP Uniform 1:00 PM - 3:00 PM Leadership Mr. Pauly Classroom YLP Uniform 3:00 PM - 5: 00 PM Speech, Etiquette & Dress for Leaders Ms. Tyler Classroom YLP Uniform 5:00 PM - 6:00 PM Dinner Cafeteria YLP Uniform 6:00 PM - 7:00 PM Mr. Nielsen s Story Mr. Nielsen Classroom YLP Uniform 7:00 PM - 8:30 PM Counselor/Book Group ALL TBD YLP Uniform 8:30 PM - 9:30 PM Laundry/Study/Social Time Dorm 9:30PM Lights Out
7 Day 3 Monday, June 15, :30 AM - 7:00 AM Wake-up/PT ALL Outside Gym Clothing 7:00 AM - 8:00 AM Breakfast Cafeteria YLP Uniform 8:00 AM - 10:00 AM Juvenile Violence Ms Baldwin Classroom YLP Uniform 10:00 AM - 12:00 P Leadership and Organization Ms. Harris Classroom YLP Uniform 12:00 PM - 1:00 PM Lunch Cafeteria YLP Uniform 1:00 PM - 3:00 PM Leadership and Organization Ms. Harris Classroom YLP Uniform 3:00 PM - 5:00 PM Goal Setting Ms Marchese Classroom YLP Uniform 5:00 PM - 6:00 PM Dinner Cafeteria YLP Uniform 6:00 PM - 7:00 PM Counselor/Book Groups ALL TBD YLP Uniform 7:00 PM 8:30 PM Sports Activities ALL Outdoors Gym Clothing 8:30 PM - 9:30 PM Laundry/Study/Social Time 9:30 PM Lights Out
8 Day 4 Tuesday, June 16, :30 AM Wake-up ALL 6:00 AM 6:30 AM Breakfast ALL Cafeteria YLP B Uniform 6:30 AM Depart for Washington D.C. ALL DEA Lower Lot YLPB Uniform 7:30 AM - 11:00 AM Tours ALL D.C. YLP B Uniform 11:00 AM - 12:00 P Lunch ALL D.C. YLP B Uniform 12:30 PM 5:45 PM Tours ALL D.C. YLP B Uniform 5:45 PM 8:00 PM Sunset Parade ALL Iwo Jima Memorial YLP B Uniform 8:30 PM -9:30 PM Return To Academy ALL 9:30 PM Lights Out
9 Day 5 Wednesday, June 17, :30 AM - 7: 00 AM Wake-up/PT ALL Outside Gym Clothing 7:00 AM - 8: 00 AM Breakfast ALL Cafeteria YLP Uniform 8:00 AM 8:30 AM Debrief of the DC Trip ALL Classroom YLP Uniform 8:30 AM 10:30 PM 10:30 AM - 12:00 P Accountability and Responsibility Character Does Matter If not me, then who? Mr. Pauly Classroom YLP Uniform Robert Bender Classroom YLP Uniform 12:00 PM - 1:00 PM Lunch Cafeteria YLP Uniform 1:00 PM - 3:00 PM Ethics, The Essential Leadership Tool Mr. Rooney Classroom YLP Uniform 3:00 PM - 5:00 PM Time Management Ms. Tyler Classroom YLP Uniform 5:00 PM - 6: 00 PM Dinner Cafeteria YLP Uniform 6:00 PM - 7:00 PM Counselor/Book Groups ALL TBD YLP Uniform 7:00 PM 8:30 PM Sports Activity ALL Outdoors Gym Clothing 8:30 PM - 9:30 PM Laundry/Social Time DEA Dorm 9:30 PM Lights Out
10 Day 6 Thursday, June 18, :30 AM - 7:00 AM Wake-up/PT ALL Outside Gym Clothing 7:00 AM - 8:00 AM Breakfast ALL Cafeteria YLP Uniform 8:00 AM 10:00 AM Social Media and Internet Survival Ms Marchese Classroom YLP Uniform 10:00 AM - 12:00 P Constitutional Law Mr. Nielsen Classroom YLP Uniform 12:00 PM - 1:00 PM Lunch Cafeteria YLP Uniform 1:00 PM - 3:00 PM FBI Lab Presentation FBI Staff Classroom YLP Uniform 3:00 PM - 5:00 PM Introduction to Adaptability Dan Mehdi Classroom YLP Uniform 5:00 PM - 6:00 PM Dinner Cafeteria YLP Uniform 6:00 PM - 7:00 PM Speech/Vocal Selections ALL Classroom YLP Uniform 7:00 PM 8:00 PM Counselor/Book Groups ALL TBD YLP Uniform 8:00 PM - 9:00 PM Yellow Brick Road Brief ALL Classroom YLP Uniform 9:00 PM - 9:30 PM Laundry/Social Time Dorm 9:30 PM Lights Out
11 Day 7 Friday, June 19, :30 AM Wake-up ALL Gym Clothing 6:00 AM - 8:00 AM Yellow Brick Road ALL YBR Course Gym Clothing 8:00 AM - 8:30 AM Shower and Dress ALL Dorm YLP Uniform 8:30 AM 9:00 AM Lite-Breakfast Cafeteria YLP Uniform 9:00 AM 10:00 AM Resume Writing Ms Baldwin FBI Classroom YLP Uniform 10:00 AM - 12:00 P Financial Responsibility Ms Kinney FBI Classroom YLP Uniform 12:00 PM - 1:00 PM Lunch FBI Cafeteria YLP Uniform 1:00 PM - 2:00 PM Graduation Rehearsal FBI Forum YLP Uniform 2:00 PM - 5:00 PM Book Reports ALL FBI Classroom YLP Uniform 5:00 PM - 6:00 PM Dinner DEA Cafeteria YLP Uniform 6:00 PM 7:00 PM Final Exam ALL DEA Classroom YLP Uniform 7:00 PM 8:00PM Program Debrief ALL DEA Classroom YLP Uniform 8:00 PM - 9:30 PM Laundry/ Study/Packing ALL Dorm YLP Uniform 9:30 PM Lights Out
12 Day 8 Saturday, June 20, :30 AM - 7:30 AM Wake-up/Breakfast Cafeteria Business Attire 8:00 AM - 8:30 AM Class Photograph ALL FBI Forum Business Attire 8:00 AM - 9:00 AM Families Gather ALL Hall of Honor Business Attire 9:00 AM - 11:00 AM GRADUATION ALL FBI Forum Business Attire 11:00 AM Release to Parents/ Change/Load Bus ALL 11:30 AM Depart to Airport ALL 4:00 PM Return from Airports ALL
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