Never Ever Ever Give Up Global Youth Leadership Boot Camp Application

* = Required Field

First Name *

Last Name *

Preferred Name

Date of Birth *

Mailing Address *

Country

Street

City

Region

Postal Code

U.S. Citizen *

Yes

Country of Birth *

City of Birth *

Email Address *

Mobile Phone Number *

High School School Name *

High School Graduation Year *

Academic Interest

TOEFL Score (if available)

Parent / Guardian First Name *

Parent / Guardian Last Name *

Relationship to student *

Parent / Guardian Email *

Parent / Guardian Mobile Phone *

Parent / Guardian First Name

Parent / Guardian Last Name

Relationship to student

Parent / Guardian Email

Parent / Guardian Mobile Phone

YPO Chapter Affiliation

By clicking “Submit”, I provide my electronic signature and agree to receive emails, phone calls, and SMS/Text Messages from Alvernia University (AU) at the numbers I provided (land and/or wireless), including calls or texts made using automated technology, AI or prerecorded voice messages. This consent is not required to purchase services, you may also call AU at 888.258.3764.