2022 LI YDP Summer Program Enrollment

2024 Summer Program Enrollment
Leadership Initiatives is a registered 501(c)(3) nonprofit that has been fully vetted by GlobalGiving and has received their “Superstar” rating. Leadership Initiatives has also received “Goldstar” status from Guidestar, “Top Nonprofit” status from Great Nonprofits, and was awarded Georgetown University’s coveted Outstanding Community Partner award from their Center For Social Justice.
Student Information
Student First Name*
Student Last Name*
Student Email*
example@example.com
Student Phone Number*
Student Preferred Gender Pronoun (optional)
Student Gender*
Student Date Of Birth*
Please indicate your current living status:*

Currently living in the U.S./home address is within the U.S.Currently living abroad/home address is outside of the U.S.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Background Check/Non-Disclosure Agreement*
By entering your initials above you are agreeing that you and your parents must are willing to undergo a background check and sign and uphold a non-disclosure agreement as needed when working as an intern for a partner law firm, as an intern with our business partners, and/or as an intern to work with patients in the medical program. By entering your initials above, you are agreeing to both of these conditions of enrollment.
If you encounter any issues filling out the 2024 Program Enrollment Form, please call (202) 738-1115 for assistance.

Parent/Guardian Information

If one of the Parent/Guardians will be the Payer, please put their information in first.
Parent/Guardian First Name*
Parent/Guardian Last Name*
Parent/Guardian Email*
example@example.com
Parent/Guardian Phone Number*
Is Parent/Guardian address the same as the student's address?*

YesNo
Parent/Guardian Address*

Street Address

Street Address Line 2

CityState

Zip Code
Would You like to add a Second Parent/Guardian?*

YesNo
Parent/Guardian First Name
Second Parent/Guardian First Name
Second Parent/Guardian Last Name
Second Parent/Guardian Email
example@example.com
Second Parent/Guardian Phone Number
Is Second Parent/Guardian address the same as the student's address?

YesNo
Second Parent/Guardian Address

Street Address

Street Address Line 2

CityState

Zip Code
If you encounter any issues filling out the 2024 Program Enrollment Form, please call (202) 738-1115 for assistance.

Payer Information
Is the Payer information the same as the Parent/Guardian information provided?

YesNo
Payer First Name*
Payer Last Name*
Payer Email*
example@example.com
Payer Phone Number*
Please continue on to the next page to select your payment plan and form of payment.

If you encounter any issues filling out the 2024 Program Enrollment Form, please call (202) 738-1115 for assistance.

2024 Summer Program Enrollment