Follow the Leader in You - Leadership Broward Foundation

Name*

First Last

Email*

Phone*

Address*

Street Address City State ZIP Code

Date of Birth*

School Currently Attending*

Emergency Contact Name (Parent/Guardian)*

Parent/Guardian Email Address Email*

Parent/Guardian Phone*

Your Gender*

Female
Male

Do you have any special need we should be aware of?*

Yes
No

How did you learn about FLY? (check all that apply)

Guidance Counselor/BRACE Advisor
Principal
Teacher
Parent
Other

Ethnicity*

American Indian or Alaska Native
Asian
Black or African American
Caribbean American
Hispanic or Latino
White

Why do you want to participate in FLY and what do you hope to get out of the experience?*

Describe a personally rewarding or memorable experience. What did you learn through this experience?*

As a participant of FLY, you are required to attend a one-hour virtual program orientation, and 3 fun filled program days. Do you feel confident in your ability to fully commit to the FLY program?*

Yes
No