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2015 YLP – Form 01
FBI NATIONAL ACADEMY ASSOCIATES
2015 Youth Leadership Program
Candidate Information
The FBI National Academy Associates, Inc. (FBINAA), an organization comprised of law
enforcement professionals who are graduates of the FBI National Academy, Quantico,
Virginia, is offering to qualified Students (AGES 14 –16) who have demonstrated above
average academic standards (3.0 or higher on a 4.0 scale), as well as good citizenship, the
opportunity to participate in an eight day program of leadership development at the FBI
Academy/DEA facilities in Quantico, Virginia
This exciting program is offered through the cooperation of the FBI and DEA, and individual
participants are selected and sponsored by the various state chapters of the FBINAA, who will
pay transportation and student sponsorship fees. This year, participants will also be included
from our sister organizations, including LEEDA, NEIA, and the Society of Former Special
Agents of the FBI. Further, the counselors and instructional staff for the program consist of
National Academy graduates who are members of the FBINAA and select FBI Special Agent
personnel. Guest lecturers in various professional disciplines also address the students.
Although the program is not limited to young persons interested in a future career in law
enforcement, interested candidates should possess a desire to gain knowledge of the American
system of criminal justice, as well as ethics, leadership skills and personal development.
This year’s session of the Youth Leadership Program begins June 13, 2015 with arrival at
Reagan Airport in Washington, D.C., and will conclude on June 20, 2015 with departure from
Reagan Airport in Washington, D.C.
The program is open to males and females. Qualified young people are encouraged to complete
the application, including the necessary signatures, and to submit the forms to the designated
FBINAA Chapter Youth Leadership Program Representative by the due date of MARCH 13,
2015. The Chapter must make selection and submission of all required material to the FBINAA
Executive Office by APRIL 17, 2015.
Application forms are available thru the FBINAA Chapter Youth Leadership Program Contacts.
2015 YLP – Form 02
FBI NATIONAL ACADEMY ASSOCIATES
2015 YOUTH LEADERSHIP PROGRAM
Sponsor -Chapter Instructions
The information included herewith will assist your chapter/association should you decide
to sponsor a candidate to this year’s session of the FBI National Academy Associates
(FBINAA) Youth Leadership Program. Aside from the basic requirements, high school
students, must be physically and medically fit to meet the program activities,
demonstrate good citizenship and have a GPA of at least 3.0 (on a 4.0 scale). Applicants
must also submit a one-page essay entitled “What is Leadership?” and undergo an oral
interview conducted by a screening committee composed of active members of the
sponsoring FBINAA, Inc. Chapter or sponsoring association. All forms must be
submitted with the application. Forms other than those labeled 2015 will be returned.
To assist you in the selection process, an optional form called The Qualification Matrix
is also provided for your use. Selection of your candidate is solely the decision of your
chapter/association.
The following is an overview of the slot allocation process:
The program has increased the number of students to a maximum of 60.
The selection process will allow each domestic and international chapter one (1)
slot (48 total).
The five (5) largest NAA chapters will automatically receive a second slot each
year. (Those are California, New York/E. Canada, Florida, Illinois, and Texas)
Those chapters may submit 2 candidates for acceptance.
Our sister organizations will each receive one (1) slot, meeting the same
requirements we have regarding membership, etc. (They are The Society of
Retired Special Agents of the FBI, LEEDA, NEIA). In the event they do not
select anyone, the extra slot(s) will be rotated through each of the Sections
starting in Section 1, 2, 3, 4.
The four (4) remaining slots will go to each of the four sections and the decision
on who gets that slot will be decided by the Chapter Presidents or designee. Any
slot not taken in a Section by a Chapter will be retained in that Section.
Applications received after April 17, 2015 will not be accepted.
Consideration may be given to announcing your chapter’s/association’s recruitment
efforts to local schools. Selection of students outside of the FBINAA membership is at
2015 YLP – Form 02
the Chapter’s discretion. Please insure that your candidate is physically capable of
participating in ALL of the program activities. You are also encouraged to seek
financial support available in your community to offset the $500.00 sponsorship fee the
chapters/associations must provide for each candidate’s attendance. Additionally,
chapters/associations must provide candidate’s airfare and transportation costs.
Sponsorship fees are used to pay incidental expenses related to field trips and excursions
in the Washington, D.C. area that are included in the curriculum. In the event that a
candidate withdraws or is dismissed from the program, the parent/guardian will be
responsible to reimburse the chapter/association for any costs expended at the
chapter’s/association’s discretion. The name of your chapter’s candidate should be
submitted to: YLP Program, FBINAA, 422 Garrisonville Rd., #103, Stafford, VA
22554, together with the following required documentation:
1. Completed Application Form.
2. Completed General Information Form with ID Photo.
3. Signed Physician Medical Release Form.
4. Scholastic Certification Letter.
5. Completed and signed Typed Written Essay.
6. Completed Oral Interview Rating and any other form used in the selection
process.
7. Copy of all forms submitted.
8. Chapter/association sponsorship fee of $500.
2015 YLP – Form 03
FBI NATIONAL ACADEMY ASSOCIATES
2015 YOUTH LEADERSHIP PROGRAM
APPLICATION
Name: ____________________________________ (M/F)______ Age ______ (DOB) ______________
Address: ___________________________________________ E-mail: ___________________________
City: ____________________________________ State: _________ Zip Code: ______________
Telephone: Area Code (_______) _______-_________ Cell Phone: (_______) _______-_________
School: __________________________________ City: ________________________ State: __________
Employment: _____________________________ City:_________________________ State:__________
Name(s) of Parent(s) or Legal Guardian(s): __________________________________________________
Address: __________________________________ City: _________________________ State: ________
Telephone: Area Code (_______) _______-__________ Cell Phone: (_______) _______-_________
Name of Employer: ____________________________________ Telephone: (_____) ______-_________
E-mail: ________________________________
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: ________________________________________________
2015 YLP – Form 03
ATTACH RECENT PHOTO HERE
January 2015 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 17, 2015
Applications received after this date will not be accepted.
This MUST be completed by candidate:
Candidate’s Sponsor: Session: Member #:
2015 YLP – Form 04
FBI NATIONAL ACADEMY ASSOCIATES 2015 Youth Leadership Program
MEDICAL INFORMATION/RELEASE FORM Required Information
Name___________________________________ DOB ______________ SS# _____________________________
Address _______________________________City ___________________________ State ______ Zip_________
Home Phone ____________________ Cell Phone ____________________ e-mail__________________________
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 ________________, 2015,
By __________________________________________.
_____________________________________________ ____________________________________
Notary Public My Commission Expires:
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 *
2015 YLP – Form 05
FBI NATIONAL ACADEMY ASSOCIATES
2015 Youth Leadership Program
ESSAY – “What is Leadership”
(Use other side if necessary)
Signature:________________________________ Print Name:________________________
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