YOUTH ALIVE CHARTER APPLICATION

School Information
Shaded areas are required information.

Campus Ministry Name
School Name
County
 Address
City
 State
Zip

Student Leaders’ Information

Student Core Leader #1 (President’s Name)
 e-mail address
Grade
 Address
Student Core Leader #2 (Vice-President’s Name)
 e-mail address
Grade
 Address
Student Core Leader #3 (Secretary/Treasure’s Name)
e-mail address
Grade
 Address

Faculty Advisor Information

Faculty Advisor
e-mail address

Identify your school ministry status:

Campus Ministry/Club
Prayer Group
Other (Please describe)

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