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:________________________