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OMEGA EDUCATIONAL FOUNDATION 501c3

P O Box 91302 Los Angeles, Calif. 90009

9th Annual YOUTH LEADERSHIP CONFERENCE

Application

Participant Name:______________________________________ Age:____ Grade____

Street Address:______________________________________________________________

City/State/Zip:______________________________________________________________

Parent/Guardian: ____________________________________________________________

Telephone Number: ( )______________

Brief description of yourself and future goals:

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School you attend:__________________________________________________

Freshman_________ Sophomore __________ Junior___________ Senior_________

Activities (list as many as you like):

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Did you attend our Youth Conference last year? Yes ______ No _______

Plans to attend College: Yes______ No_____ If yes, where would you apply for college:

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Why are you attending this youth conference? ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________