Vol Youth Leadership Academy - Office of Community Engagement and Outreach

2025 Application – Due Tuesday, May 15th at 12 PM

VYLA (Vol Youth Leadership Academy) is a collaborative initiative between the University of Tennessee, Knoxville’s Office of Community Engagement and Outreach in the Division of Access and Engagement, and its campus partners. Designed to introduce young Tennesseans to the Volunteer Creed, the Academy engages middle school students who have completed the 7th or 8th grade in learning the principles of becoming positive leaders—both for today and tomorrow. Participants take part in a variety of classes, field trips, and experiential learning opportunities, all aimed at helping them take the lead in shaping their futures. The commuter program will be June 2-7, 2025. To apply, please complete the application below.

Applicant's Name(Required)

First Middle Last

Applicant's Date of Birth(Required)

Applicant's Preferred Name

Applicant's Gender(Required)

Male

Female

Applicant's Email Address(Required)

Applicant's Cell Phone Number(Required)

Does the applicant live with their parents or other relative caregivers?(Required)

Yes

Applicant's Permanent Address(Required)

Street Address Address Line 2 City State ZIP Code

Applicant’s Anticipated School for the Fall(Required)

Parent/Guardian’s Name(Required)

First Last

Parent/Guardian’s Relationship to Applicant(Required)

Parent/Guardian’s Email Address(Required)

Parent/Guardian’s Telephone Number(Required)

Does the applicant have any special needs (physical access, visual, or auditory assistance, etc.)?(Required)

Yes

If yes, please specify

Does the applicant have any dietary restrictions?(Required)

Yes

If yes, please specify

Is the applicant currently taking any over the counter or prescribed medications?(Required)

Yes

If yes, please list ALL medications you are taking

Name of the Applicant's Primary Care Physician(Required)

First Last

Telephone Number of Applicant's Primary Care Physician(Required)

Does the applicant have any limiting medical conditions that the applicant, the parent/guardian, and/or participant’s doctor believe may limit program participation?(Required)

Yes

If yes, please identify the condition and explain its limiting effect below

Is the applicant currently taking any medication that applicant, the parent/guardian, and/or the applicant’s doctor believe may interfere with their ability to participate safely or effectively in the program?(Required)

Yes

If yes, please identify the condition and explain its limiting effect below

Does the applicant have a history of allergies or reactions to medications, insect stings, plants, or foods?(Required)

Yes

If yes, please identify the condition and explain its limiting effect below

Does applicant have a history of, or currently suffer from, any other medical condition(s) of which the program staff needs to be aware?(Required)

Yes

If yes, please identify the condition and explain its limiting effect below

Policy Holder's Name(Required)

First Last

Medical Information and Medical Treatment Release and Authorization

Policy Holder’s Relationship to Applicant(Required)

Policy Holder’s Address(Required)

Street Address Address Line 2 City State ZIP Code

Please provide a photocopy of both sides of your insurance card (preferred) or submit the information requested in the fields below.(Required)

Max. file size: 2 MB.

Insurance Company’s Name(Required)

Telephone Number of Insurance Company(Required)

Policy Number(s)(Required)

Authorization for Medical Treatment – Digital Signature of Parent or Legal Guardian(Required)

In the event of an accident or serious injury or illness, I hereby authorize The University of Tennessee and its trustees, officers, employees, agents, and volunteers in official and individual capacities (“Releasees”) to obtain medical treatment for the applicant. I further agree to accept full responsibility for any and all expenses, including but not limited to medical expenses, that result from, arising out of, or are related to any injuries to the applicant that may occur during their participation in the program, Applicant’s travel to or from the program, or applicant’s presence on premises owned, leased, or operated by Releasees, INCLUDING BUT NOT LIMITED TO INJURIES SUSTAINED AS A RESULT OF THE NEGLIGENCE OF RELEASEES. As the applicant’s parent or legal guardian, I understand and acknowledge that my failure to disclose relevant information may result in harm to the applicant and/or others during this program. By signing below, I represent and warrant that I have provided all material information to The University of Tennessee pertaining to the medical condition(s) identified above and that it is accurate and complete. I agree to notify The University of Tennessee in writing of any changes in the medical condition of the applicant prior to the start of the program. I understand that my disclosure of the medical information above will not be used by The University of Tennessee to determine the applicant’s ability to participate safely in the program. I understand that, if the applicant participates in the program, they do so voluntarily and of their own accord and the final decision regarding participation is solely the responsibility of applicant, me, and/or their physician(s).

Date(Required)

Digital Signature of Applicant(Required)

Photographic Image Release – Digital Signature of Parent or Legal Guardian(Required)

During the course of the Vol Youth Leadership Academy, we would like your permission to take photographs of your child as they take part in various academy activities/events. The photographs help us to document our students’ experiences. As your child’s parent(s)/legal guardian(s) we need your permission to record their picture. By clicking the box below, you give The University of Tennessee, Knoxville, the right to take photos of your child as they participate in the Summer Institute and acknowledge the following. I grant the University of Tennessee, Knoxville, its representatives, and employees the right to take photographs of my child in connection with the 2025 Vol Youth Leadership Academy. I authorize the University of Tennessee, Knoxville, and its lawful representatives to copyright, use, and publish the same in print and/or electronically. I agree that the University of Tennessee, Knoxville, may use such photographs of my child with or without their name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and web content.

Date(Required)

Research Participation Agreement – Digital Signature of Parent or Legal Guardian(Required)

During the course of the 2025 Vol Youth Leadership Academy, we would like your permission to have the applicant participate in research related to key aspects of the academy. In some classes and group discussions, the applicant may be asked to complete online questionnaires and keep a journal related to the following: • Academy curriculum and programming topics. • Hope about the future. • Outlook for college, trade, or technical schools. • Feedback about the summer academy (what their experience was like and how it can be improved). The short questionnaires will help us gather baseline information about the applicant on related topics. The journals will help us document the students’ experiences as well as obtain their feedback about important aspects of the Vol Youth Leadership Academy. As the applicant’s parent(s)/legal guardian(s) we need your permission to administer questionnaires to the applicant and authorization for the applicant to keep a journal as a part of VYLA. The applicant will not be required to place his or her name on any document used for research purposes but will be issued a number to protect their confidentiality. By signing below, I grant the University of Tennessee, Knoxville, its representatives and employees, the right to administer related questionnaires to the applicant and review the journal kept by the applicant as a part of the 2025 Vol Youth Leadership Academy. I authorize the University of Tennessee, Knoxville, and its lawful representatives to publish the results of data collected from questionnaires and journals in the final academy evaluation report and scholarly articles about the academy.

Date(Required)

Transportation Release Agreement – Digital Signature of Parent or Legal Guardian(Required)

As the parent/legal guardian of the applicant, I authorize and request The University of Tennessee, Knoxville to provide transportation for my student on field trips and programmatic outings that may take place during the Vol Youth Leadership Academy, June 2025. In exchange for The University of Tennessee’s agreement to provide transportation for my student, I agree to release The University of Tennessee, Knoxville, and its officers, employees, and agents from any claims, including claims concerning illness or injury that might occur during these trips.

Date(Required)

For More Information Please Contact:

Office of Community Engagement and Outreach

Phone: 865-974-4841

Email:mwalke84@utk.edu