InIt 2013* Delegate Application

Youth Leadership InItiative (InIt) is a social justice leadership training program of YWCA Boston for high school students from many different backgrounds and communities. InIt starts in the summer with a powerful “InIt Immersion” overnight retreat focused on diversity and social justice. It continues through the academic year with ongoing programming and support, which allow the student delegates to impact one or more aspects of social justice in their schools and communities. InIt participants engage in dialogue, workshops, and exercises that focus on understanding prejudice and oppression at all levels, honing skills that create understanding across differences, and strengthening their commitment to lead. All participants come as part of a delegation from a sponsoring school or community organization.

To apply for InIt, you must submit ALL of the following: 1. InIt 2013 Delegate Application (with all sections completed) 2. Student Statement of Commitment 3. Parent/Guardian Statement of Commitment 4. Delegate Nomination Form (can be sent separately by your sponsoring school or community organization) 5. Partner Statement of Commitment (same as # 4)

Personal Information
First Name: ___________________________________ Last Name: ___________________________________

Address: _____________________________________________

Apt: _______________

City: ______________________________

State: _______________

Zip: _______________

Phone Number(s): (h) ________ - ________ - ________

(c) ________ - ________ - ________

Email: ___________________________________

Date of Birth: ________ / ________ / ________

High School: ______________________________

Year of Graduation: _______________

Parent/Guardian Name: _________________________

Parent/Guardian Email: _________________________ (continued)

*As InIt is a ten-month program, the “class” that participates in the program beginning in the summer of 2012 is known as the InIt Class of 2013.

Name: _______________________________________

Understanding social justice and diversity requires a wide variety of backgrounds and life experiences. To help us plan for a diverse mix at InIt, please describe yourself below.

Gender: ______________________________

Racial Identification: ___________________________________

Ethnic/Cultural Identification: _________________________________________________________________________ Religious Identification: ______________________________________________________________________________ Any other aspects of your identity you would like to share and feel would contribute to your (and others’) InIt experience (e.g., sexual orientation, disability, immigrant status, etc.) __________________________________________________________________________________________________ __________________________________________________________________________________________________ Any special dietary, physical or religious needs? (Note: This will not affect your application to the program) __________________________________________________________________________________________________

How did you learn about InIt? _________________________________________________________________________ __________________________________________________________________________________________________

InIt 2012-2013 Program Year
• The “Immersion Week” overnight retreat will be held Monday, August 13th – Friday, August 17th, 2012, at Rolling Ridge Conference Center in North Andover, MA. • InIt Saturday Program Days [10:00am – 5:00pm]:  Saturday, September 22, 2012  Saturday, October 20, 2012  Saturday, November 10, 2012  Saturday, December 1, 2012  Saturday, January 26, 2013  Social Justice Arts Slam: Saturday, February 9, 2013  Saturday, March 2, 2013  Saturday, April 6, 2013 Graduation: Thursday, May 16, 2013 ** Participants are required to attend all program days, Social Justice Arts Slam, and Graduation

Name: _______________________________________

Activities & Experience
On a separate piece of paper, please tell us about the following (or, instead, you may submit a résumé if it addresses the following): 1. Any activities you are or have been involved in at school or in the community 2. Any work experience (paid or unpaid) you have 3. Any leadership experience you have – formal or informal (current or previous leadership experience is not necessary in order to be accepted into InIt) 4. Any activities or interests involving social justice (if different from #1) 5. Anything else you would like us to know about your activities and experience

Personal Statement
Part I: In a statement of 200 words or less, please tell us why you are interested in participating in InIt and in what specific ways you think you will be a successful participant in this program. (We want to know how you intend to be a committed participant at the retreat and in the workshops, and an effective leader in your school or community.) AND Part II: In a statement of 300 words or less, please answer one of the following questions: 1. What issues or conflicts in your school or community are most troubling to you and do you want to see changed? What actions can you take to help make this change? 2. What is your definition of a leader? How did you come up with this definition? 3. If you could create a club, or put on a workshop or presentation, in your school or community that would help spark others’ interest in social justice issues, what would it be – and why?

We certify that all the information in this application is true. Student Delegate signature: ________________________________ Date: _____________________

Parent/Guardian signature: _________________________________

Date: _____________________

Your application must be submitted by Saturday, June 30, 2012. After June 30th, we will continue accepting applications if there is still space available. Please submit your application and supporting documentation by email, mail, or fax to: Ruben Ocan Ortiz YWCA Boston 140 Clarendon Street Boston, MA 02116 Fax: 617-585-5499 Any questions, call Ocan at 617-585-5462

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