2024 Staff Application Form

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IEFLP 
Staff Application 
Latino Student Leadership Conference 
June 9 - June 14, 2024 


Dear Future Leader:

 

You learned a lot from camp and now you want to come back and be a Staff Member, right? Well, here’s your chance to be part of the hardworking, energetic, and dedicated staff of our Inland Empire Future Leaders Program.

 

Our conference will be held from June 9–14, 2024. Selected staff members will attend mandatory staff training workshops on: March 3 (support staff only), April 14, May 19, and June 2 from 12-4pm.

 

As a Staff Member, you must be able to set a good example for new Future Leaders by maintaining a positive attitude, demonstrating your academic strengths, and by demonstrating that you are a mature, responsible, and enthusiastic Future Leader.

 

The deadline to submit the online application is February 2, 2024 (11:59 pm). All staff members/volunteers must be fully vaccinated against COVID-19 (no exceptions).

 

Further information will be provided with staff acceptance notification letters.


If you need any additional information, email us at application@iefl.org. We also encourage you to connect with us on social media to learn more about important events.

 

 

Sincerely,

 

Dr. R.C. Heredia
Director












Gender Identity

Birthdate




Address





Additional Information





















Tell us about offices, clubs, organizations, organized sports, or hobbies in which you have been active. You may also include work experience and Future Leader Activities. 

*Please add a new response for each activity*






Grades


Tell us about offices, clubs, organizations, organized sports, or hobbies in which you have been active. You may also include work experience and Future Leader Activities. 

*Please add a new response for each activity*






Grades

Resume


Please list a total of three activities in order of preference for the Cultura Sessions which you would like to lead: 











Ex. 2018-2022 or 2021-Present





Please list your experience relevant to this conference. List experience you have had working with youth and specify whether this work has been community, school, church, or other related work. (Please indicate previous participation with IEFLP). 

Resume


Please list a total of three activities in order of preference for the Cultura Sessions which you would like to lead: 




Include the following items in your essay: 
  1. Skills you have which would make you a valuable Graduate Apprentice. 
  2. Why you want to be a Graduate Apprentice.
  3. What you think the role and responsibilities of the Graduate Apprentice should be. 
Note: You are strongly encouraged to get help from your parents, teachers, a counselor, or your principal in the preparation of this essay. 

Get two letters of recommendation.  Get one letter from a teacher and the other from a counselor, principal, clergyman, or community leader.
(File types accepted include: .doc, .pdf, .jpg, .png) 



Please write a 250-word essay addressing the following points:  
  1. What do you think the roles of a Peer Counselor are? 
  2. Why would you like to be a Peer Counselor? 
  3. Why should you be selected as a Peer Counselor? 
  4. What would you contribute to the program, the delegates, and fellow staff members? 

Get one letter of recommendation. If in high school, get a letter from a teacher or counselor. If in college/ university, get a letter from an instructor, school official, or community leader. (File types accepted include: .doc, .pdf, .jpg, .png) 


Please write an essay addressing the following points:  
  1. What, in your view, is a Facilitator? 
  2. Why would you like to be a Facilitator? 
  3. Why should you be selected as a Facilitator? 
  4. What would you contribute to the program, the delegates, and fellow staff members? 


Please write an essay addressing the following points:  
  1. What, in your view, are the responsibilities of the position for which you are applying? 
  2. Why would you like to hold that position at IEFLP? 
  3. Why should you be selected to hold that position?
  4. What would you contribute to the program, the delegates, and fellow staff members? 


If you are to participate in the IEFLP Leadership conference, you and your parents/guardians (if under 18) must complete this health clearance form. You cannot attend the conference if this information is not submitted.

Note: All medical history is considered confidential.

**PLEASE MAKE SURE YOU SUBMIT A COPY BELOW OF ALL VACCINATION RECORDS, INCLUDING COVID VACCINATION CARDS.**
Personal Data






Birthday



Health Insurance Information






Please submit a copy/picture of the front and back of your health insurance card below. (File types accepted include: .doc, .pdf, .jpg, .png) 


Immunizations


**PLEASE MAKE SURE YOU SUBMIT A COPY BELOW OF ALL VACCINATION RECORDS, INCLUDING COVID VACCINATION CARDS.**
Measles, Mumps, and Rubella (MMR)
Date of 1st dose: 



Date of 2nd dose: 



Tetanus/TDAP
Date of last dose: 



Immunization Record
Please submit a copy of your immunization vaccination records below. Please make sure your name appears. (File types accepted include: .doc, .pdf, .jpg, .png) 


COVID-19 Vaccine
Only 2 doses required, 3rd optional. 
Date of 1st dose: 




Date of 2nd dose: 




Date of additional dose (i.e. booster): 




Please submit a copy of your COVID Vaccination records below. (File types accepted include: .doc, .pdf, .jpg, .png) 


Medical (Medications, Allergies, Dietary Restrictions) 

Medications






Allergies




Dietary Needs



Please initial here
Impairments


Limitations


Other


Consent Forms
Please read the following forms and provide signatures below: 

Agreement and Medical Release Form

Consent

My signature below indicates that I have read and consent to all documents above. I affirm that the information provided by me/us in this health clearance form is correct, and I consent to its release to IEFLP. 


Consent Forms





My signature below indicates that I have read all documents above and provide consent to apply for the IEFLP conference. I affirm that the information provided by me/ us in this application is correct, and I consent to its release to IEFLP. 


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