2016 Chicag Chinese Youth Leadership Award Application Form

2016 CCYLA Program Committee

Student Information
English Name: Chinese Name:
Date of Birth: Gender: Male Female
High School: Name:
Junior  Senior 
2015 GPAs (Fall/Spring):
Farther Information
English Name: Chinese Name:
Phone: Email:
Mother Information
English Name: Chinese Name:
Phone: Email:
Reference 1 Information
Name: Title/Organization:
Phone: Email:
Reference 2 Information
Name: Title/Organization:
Phone: Email:
Nominating Chinese School or Local Chinese Community Organization
School: If select Local Chinese Community Organization, please fill in line below.
Organization: Leader Name/Email/Phone:
         
-- Please submit this form by January 25, 2015.
-- If the number of submitters less than the minumum size of applicants by the date, we will extend the date until the minimum size reached.
-- Applicant is allowed to submit multiple times. Only the latest submission will be taken.
-- Please read the CCYLA Program Announcement before submit this form.
-- Applicant does not requir to be a student/member of his/her nomining Chinese school or local Chinese community organization.
-- The nominating local Chinese community organization has to be active with 100 or more members. Or it's a group member of CAAGC. CCYLA program committee has the right to do the final judge if the orginazation is qualified to nominate applicants. You can ask the leader of the orginazation to contact CCYLA program committee about the qualification.
-- After complete this form, please send your application documents to your nominating schools or nominating organization and cc to youth@caagc.org .