OMEGA PSI PHI FRATERNITY, INC.

Theme: Control Your Destiny or Someone Else will

OMEGA EDUCATIONAL FOUNDATION 501c3

P O Box 91302 Los Angeles, California 90009

16th Annual YOUTH LEADERSHIP CONFERENCE

Application

Participant Name:______________________________________ Age:____ Grade____

Street Address:______________________________________________________________

City/State/Zip:______________________________________________________________

Parent/Guardian: ____________________________________________________________

Telephone Number: ( )______________ Cell #______________ T-Shirt Size________

Brief description of yourself and future goals:

_____________________________________________________________________________________

School you attend:__________________________________________________

Activities (list as many as you like):

_____________________________________________________________________________________

Did you attend our Youth Leadership Conference last year? Yes ______ No _______

Plans to attend College: Yes______ No_____ If yes, where would you apply for college:

__________________________________________________________________________________

Why are you attending this 16^thAnnual Youth Leadership Conference? ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________