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About Us
Board of Directors
Staff
Employment Opportunities
News
Programs
University of Arizona YIP
University of Michigan YIP
Results
2019 Annual Report
Previous Annual Reports
Media
Donate
Permanently Impacting our Nation's At-Risk, Inner-City Youth
Michigan YIP Application
University of Michigan Youth Impact Program Application 2021
Please use this form to apply to the University of Michigan Youth Impact Program 2021.
Michigan YIP 2021
Name
*
First
Middle
Last
Email:
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Date of Birth
*
MM
DD
YYYY
Grade as of Fall 2021 (6th, 7th, 8th Grade)
*
6th Grade
7th Grade
8th Grade
School
*
School District
*
Height
Weight (in lbs)
Does your child have any medical/physical conditions?
Is your child currently on medication?
*
Yes
No
Please list any medications:
Does your child have any allergies?
*
Yes
No
Please list any allergies:
Adult T-Shirt Size
*
Small
Medium
Large
XLarge
XXLarge
Adult Shorts Size
*
Small
Medium
Large
XLarge
XXLarge
How did you hear about the program?
*
Is your child a returning participant?
*
Yes
No
Student Essay
Please write at least 5 sentences (a paragraph) telling us why you deserve to be selected to attend the University of Michigan Youth Impact Program and how the program can help you with your future dreams.
Parent Guardian Information
Name
*
Mr.
Mrs.
Miss
Ms.
Dr.
Prof.
Rev.
Prefix
First
Last
Relationship to Student
Home Phone Number
Cell Phone Number
*
Email
*
Enter Email
Confirm Email
Statement of Responsibility:
I, the Legal Guardian, understand that in completing this application, I support my child in participating in this academic and athletic program.
*
Agree
Disagree
I will not schedule vacation time or admit my child into other camps during the program dates, otherwise I forfeit their spot as to allow another camper to attend.
*
Agree
Disagree
Photo & Video Release for Minor Children - I authorize YIP to publish any photographs and videos taken of my undersigned minor child, for use in printed publications, website and social media sites.
*
Agree
Disagree
I assume FULL risk and responsibility for their commitment and participation in this program and I agree to waive any claims against the YIP and the University of Michigan.
*
Agree
Disagree
Bus Stop Location
Detroit PAL
4-H Community Center
facebook
twitter
linkedin
youtube
Email Signup
Phone
This field is for validation purposes and should be left unchanged.
Upcoming Programs
June 14, 2021 - Jun 25, 2021
Youth Impact Program at University of Arizona 2021
June 25, 2021 - Jul 04, 2021
Youth Impact Program at University of Michigan 2021
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