Online Application Form

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South Shore - Marion County Youth Leadership Team

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Online Application Form

Application may be made using a form which can be obtained from the school counselors (Flippin, Bruno-Pyatt, or Yellville Schools) or the Marion County Cooperative Extension Service (870-449-6349), or a student may use this online application form. Be sure to fill in all the information before submitting. If any fields do not apply to your request, please insert n/a (not applicable).

Name:
Address:
City:
State:
Zip:
Phone:
E-mail:
1. Whom do you look up to or admire? Why?

2. Who is your favorite fictional character? Why?

3. Who is your least favorite fictional character? Why?

4. Describe one personal goal you want to accomplish by age 21.

5. What do you think are your best qualities and strengths?

6. Describe why you want to participate in the South Shore - Marion County Youth Leadership Team and how you will benefit personally from a leadership program.

Please note: There will be a $20 enrollment fee if you are selected. Scholarships are available.

South Shore • 301 East Main Street • P.O. Box 209 • Flippin, AR 72634 • © , All rights reserved • www.southshore.com
(870) 453-8800 • (800) 775-6682 • South Shore was founded by and is fully supported by NATCO (Northern Arkansas Telephone Company).