C5 Georgia Program Application

Create An Account to Return and Complete

Create an account so you can save your progress and complete this form later. Once you've created an account, just login and continue work on your application. Click the SAVE PROGRESS button at the bottom of the application when you add new information. Once you have completed your application, click the SUBMIT button at the bottom of the application to let us know you have completed all parts.

STUDENT INFORMATION

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Are there any previous student(s) accepted into the Program within the household? *

Primary language spoken at home: *
 
Race (Optional), Applicant may report multiple races:
 
Ethnicity (Optional):

PARENT INFORMATION

2nd Parent/Guardian Information (Optional):
Has either of the applicant's parents received a 4-year degree from an accredited college in the United States? *
PARENT/GUARDIAN CONSENT ITEMS:
Support of Student Application: I understand that C5 Georgia Youth Foundation provides a 5-year leadership development program that includes up to four weeks of overnight camp each summer and 3 – 4 required events throughout the school year. I support my student’s application to the C5 Georgia Youth Foundation. *
Consent to Applicant Interviews: All candidates may not be interviewed. A C5 Georgia representative will contact the nominator and the parent/guardian of the student if they have been invited to interview in early January. Interviews last 1.5 – 2 hours. The interview schedule will be published when students are notified of interview. Interviews consist of two parts: 1. a one-on-two interview involving the student, a C5 Georgia staff member and a C5 Georgia volunteer. The student will be asked questions regarding their personality and experiences in school and in the community,  2. Working in a group with other applicants. A C5 Georgia facilitator will lead group games and problem solving activities. The group session is active but does not involve sports or athletic activities. Sturdy shoes are recommended. While unlikely, because the group interviews are active, minor injuries such as those that might be caused by bumping into another person are possible.

I give permission for my student to participate in the C5 Georgia interview process. *
Consent to Use Films/Photos: I give permission to the C5 Georgia Youth Foundation to use films and photos of my student during the interview process for identification purposes as well as to promote C5 Georgia. This includes appearances in brochures, blog stories, and other media. *
Consent to Access Grade Reports: I grant permission to C5 to access my child’s grade reports and attendance records through his/her school. My child’s report card may be photocopied. I understand this is for the purpose of assessing C5 Georgia’s impact on academic performance. I understand that my child must maintain a minimum 3.0 GPA in order to continue participating in C5 Georgia activities. *
Support of Student Participation in C5 Georgia Programming: If my student is selected to participate in C5 Georgia Youth Foundation, I agree to attend 1 – 2 parent meetings each year. I understand that I am responsible for transporting to 3 – 4 events during the school year. I also understand that C5 Georgia requires students in its program to perform 250 hours of community service during the 5-year commitment. *

FINANCIAL DISCLOSURE

APPLICATION WILL NOT BE CONSIDERED IF THE INFORMATION BELOW IS NOT COMPLETE.
 
C5 Georgia Youth Foundation programs are extended to students from families that lack resources for quality enrichment experiences like those offered by C5 Georgia. Income and other financial considerations are a factor in determining eligibility and in the selection of students. Reporting your family income is required. All information is strictly confidential.
Parent Signature: *
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STUDENT FREE-RESPONSE

ESSAY

Describe, in as much detail as you can, the most difficult experience in your life.  How did you overcome this situation? What did you learn about yourself in the process? How have you grown from it?

+Use your best effort when writing your essay, it is a very important part of your application.

+Applications without essays will not be considered.

+Essays should be 1 – 2 pages in length.

+Type your essay if possible; use additional pages as needed.

RECOMMENDATIONS

Recommendation Forms | A and B

Two recommendations must be completed by two different recommenders who know you well and can describe why you are a good candidate for C5 Georgia’s leadership program. Coaches, teachers,
mentors, counselors, pastors and youth leaders are excellent choices to complete recommendations.
Recommendations should NOT come from immediate family members or from the person who
nominated you. At least ONE of the recommendations should come from a teacher, counselor, or administrator at YOUR school.

Recommendations are collected electronically.  Copy each link below and send to your chosen recommenders.  Recommendation A to one person and Recommendation B to a separate person.

A | https://www.surveymonkey.com/r/RecommendationA

B | https://www.surveymonkey.com/r/RecommendationB
 
Make sure you ask that they complete their recommendation before the December 12, 2021 deadline.
 

GRADE REPORT

Attach a copy of your most recent grade report. If your GPA is below 3.0 (on a 4-point scale), you must submit one extra letter of recommendation from a teacher or counselor outlining steps you are taking to improve your grades.


FINAL ITEMS

Student Commitment
By signing this document, I am expressing my interest in being part of the C5 Georgia Youth Foundation program. I understand that C5 Georgia is a leadership development program and I want to be a positive leader in my community. If I am selected, I am prepared to attend up to four weeks of camp each summer and 3 – 4 events during the school year. I understand that I am expected to perform 250 hours of community service during the 5-year commitment, and must maintain a minimum 3.0 GPA.
Student Signature *
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