2024 Student Application Form

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Page 1 - Introduction

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


Dear Student: 
 
If you are an eighth- or ninth-grade Latino student, here’s your chance to become part of a very special leadership program. 
 
We’ll be selecting 120 students to attend a summer conference from June 9 to June 14, 2024. 
 
You’ll learn skills that will help you become an effective leader in your school, and eventually in your community, in business and in government.   
 
You’ll learn to be proud of your heritage, develop and use your leadership skills, and be empowered to seek opportunities for educational and professional growth. 

Your meals, lodging, and transportation will be paid by  generous contributions from private industry, civic organizations, and individuals. If you are accepted, you will be  asked to pay a $40 fee* to cover insurance, a group picture, a T-shirt, and educational materials. 

*$40 fee may be paid by the student's school district in some cases, to be determined in May, 2024.


To be considered for this unique experience, you must:  

1. Be fully vaccinated for COVID-19 (now optional as of 3/4/24).

2. Be in eighth or ninth grade this year.

3. Have demonstrated academic and leadership potential. 

4. Have a 2.5 GPA or higher on your current transcript 

5. Complete and submit the IEFLP application online no later than APRIL 15, 2024 by 11:59 pm (New Due Date). Students will be notified the first week of May, 2024, if accepted. 
 
 
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









Background Information



Contact Information















Page 3- Activities 

Tell us about offices, clubs, organizations, organized sports, or hobbies in which you have been active. You may also include work experience and activities outside of school. 








Page 4 - Autobiography

Write a 250-word autobiographical essay. Be sure to include the items listed below in your autobiography. Each topic below counts as 1/5 of your total essay score. 

1) Who you are, your place of birth, places where you have lived, and what your family is like

2) Activities in your school, at church, at home, and in the community

3) Your interests, hobbies, work experience (if any)

4) Your educational and career goals; college(s) you would like to attend

5) Tell us why you think you have leadership potential 

Note: You are strongly encouraged to get help from your parents, teachers, a counselor, or a school administrator in the preparation of this essay. 

** Hint: make each of the five items required be a paragraph in your essay. 

Page 5 - Grades

Required: Upload a copy of current school transcripts. 

Note: Upload a PDF copy or take a picture with your cell phone camera of these documents (File types accepted include: .doc, .pdf, .jpg, .png) 




Page 6 - Letters of Recommendations

TWO LETTERS OF RECOMMENDATION. Request one letter from a teacher and the other from a counselor, principal, a clergy member, or community leader. Have them write your letters of recommendation on school, organization or company letterhead. (Letters from immediate family or relatives will not be accepted).  

Click here for more information on how to request a letter of recommendation.

(File types accepted include: .doc, .pdf, .jpg, .png) 


Medical Cleareance

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

Please answer all Student Medical History questions on this page and provide electronic signature on Page 8.

Note: All medical history is considered confidential. 
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 SUBMIT A COPY BELOW OF ALL VACCINATION RECORDS, INCLUDING COVID VACCINATION CARDS (COVID-19 vaccination records are optional).**
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
(optional).
Date of 1st dose:



Date of 2nd dose:



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



(OPTIONAL) 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



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. 


Page 8 - Consent Forms 





My signature below indicates that I have read all documents above and provide my consent for my student 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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