Our Space & Facilities
Youth CAUSE Initiative 2022 Application Form
Please complete the online "Youth CAUSE Initiative form" below by
MONDAY 9 MAY 2022
. NO PAPER COPIES WILL BE ACCEPTED. For questions please contact Dr. Rob at
Indicates required field
Youth CAUSE Initiative Applicant Name
Date of Birth
I identify my gender as:
I'd prefer not to disclose
Participant Phone Number
School enrolled for 2022-23?
Grade level for the 2022-23 school year?
Elementary School - Grades 3-5
Middle School - Grades 6-8
High School - Grades 9-12
Parent/Legal Guardian Details
Please complete this section if participant is 18 years of age or younger.
Parent/Legal Guardian Name #1
Parent/Legal Guardian Name #2 (Optional)
Best Parent Phone Number
Parent Email #1
Parent Email #2
Application Timeline & Program Expectations
The following timeline will be used when considering applications:
November 18, 2021 - Applications open
February 14, 2022 - Final day for applications
Early March 2022 - Ambassador candidates invited for interviews
May 9, 2022 - Earth Day - Successful applicants announced for summer 2022 program
July-Aug 2022 - 2022 Youth CAUSE Initiative Programs
Please check the boxes for the weeks the participant will be attending the Youth CAUSE Initiative workshops. Workshops run Monday through Friday. Note that
attendance is mandatory for workshops of Aug 1-5 and Aug 8-12
in order to participate in the Youth CAUSE Initiative program.
If selected for the program, I will be participating in the following weeks of the Youth CAUSE Initiative program (Min. 4 weeks to be selected):
July 7-8: Youth CAUSE Orientation
July 12-15: Intro to Coding & Technology Week
July 19-22: Climate Science Week
July 26-29: Science Communication Week
Aug 1-5: Hackathon Week
Aug 8-12: Media Week
Please provide brief answers (no more than 5 sentences) to the following questions:
Why do you want to be a youth ambassador?
What interests you about science?
What is the most important topic that needs to be solved in Wilmington?
Pick-up and School Transportation Planning
We have designed our program to be flexible and to accommodate participants that attend
traditional and year round schools. No one is going to miss out on opportunities to experience science. We will be open
Tuesday through Friday from 8a to 4p
with the occasional
Saturdays reserved for family field trips (to be confirmed)
. For those Ambassador participants that do not have access to transportation, we are able to provide
home pick up and drop off as well as school pickup.
Please indicate your transportation needs below. Spaces are limited but we will do everything to accommodate all needs of the youth:
My child will require pickup from his/her residence each day between 7.30-9a:
My child attends a year-round school and will require school pickup:
My child will require drop off at his/her residence at the end of each day:
Digital signature of parent or guardian
Parent or legal guardian should state their full name which will serve as a digital signature to acknowledge their understanding of the terms and conditions of registering for YSA programs.
relationship to student
I agree to receiving marketing and promotional materials
Young Scientist Academy // 501(c)(3) EIN 81-4999928
Suite 420, 20 N 4th Street
Wilmington, NC 28401
Ph: (910) 386-1867
Our Space & Facilities