Strengthening Our Community

North Jefferson Student Leaders Application

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Applicant Information

Student Name(Required)

Preferred Name

School(Required)

Grade for the 2026-2027 School Year(Required)

Student Email Address(Required)

Student Phone Number

Parent/Guardian Name(Required)

Parent/Guardian Email(Required)

Parent/Guardian Phone(Required)

About You

Why are you interested in participating in North Jefferson Student Leaders?(Required)

Please answer in your own words.

What do you hope to learn or gain from this program?(Required)

Leadership Skills

Professional Communication/ Public Speaking

Career Exploration/ Networking

Community Service

Workforce Readiness

Tell us about a time when you took initiative to solve a problem, help someone, or improve a situation.(Required)

This can be at school, work, church, sports, home, or in your community.

What is one quality that makes you a dependable team member?(Required)

What is one skill or area where you would like to grow?(Required)

Community & School Engagement

Are you currently involved in any activities, clubs, sports, work, volunteer service, church groups, or organizations?

Participation is not required. We simply want to learn more about you.

What is something positive about your school or community that you think deserves more recognition?(Required)

Video Submission

Video Response Required: Please submit a video no longer than 2 minutes answering ONE of the following prompts:

Option A: What is a need you see in your school or community, and how would you help address it?
Option B: Tell us about a time you identified a problem and took action to help solve it.
Option C: If you had the opportunity to improve one thing in North Jefferson for students your age, what would it be and why?

Videos do not need to be professionally produced. We simply want to hear directly from the student.

Upload Your Video(Required)

Accepted file types: mp4, mov, m4v, webm, Max. file size: 2 GB.

Upload one video file. Recommended maximum length: 2 minutes.

Commitment

Student Commitment(Required)

I understand that if selected, I will be expected to attend monthly meetings.

I understand that I will be expected to participate respectfully.

I understand that I will contribute to the class community project.

I understand that I will represent my school and community positively.

Please check each box to confirm your understanding.

Student Signature / Typed Name(Required)

Parent/Guardian Signature / Typed Name(Required)

Reference

Please provide one reference who can speak to the student's character, work ethic, or dependability. This may be a teacher, coach, employer, youth leader, counselor, or another trusted adult who is not an immediate family member.

Reference Name(Required)

Relationship to Applicant(Required)

Reference Email(Required)

Reference Phone