YIMA

Application & Registration Forms

All Forms are Available Below

Please Select, Complete & Submit the Proper Forms

(Please Note: All Application Fees are Non-Refundable)

Downloadable Registration Forms

(to be mailed or faxed in)

YIAA Application Form

YIAA Registration Form

YIAA Pre-Evaluation Form

YIAA Post-Evaluation Form

YIMA Application Form

YIMA Registration Form

Youth Initiative Mentoring Academic (YIMA) - Registration Form

Last Name:

First Name:

Middle Init.:

Phone:

Email:

Address:

City:

State:

Zip:

Age:

Date of Birth:

Goes to School Where?

Driver’s License No.: Collected later

Social Security No.: Collected later

Place of Employment:

Business Phone:

Additional family members taking lessons:

Referred by:

Father’s Last Name:

First:

Middle Init:

Age:

Mother’s Last Name:

First:

Middle Init:

Age:

Indicate which parent: Father: Mother:

Address:

City:

State:

Zip:

Phone:

Drivers License No.: Collected later

Social Security No.: Collected later

Place of Employment:

Business Phone:

Field trips are an important part of the Youth Initiative Aviation Academy. Your signature authorizes your son/daughter/ward to attend field trips that are developed as part of this class. We understand that the necessary arrangements/plans/precautions will be taken for the care and supervision of the student during this trip.
I/We authorize to participate in Youth Initiative Aviation Academy field trips.

Registrant’s Signature (or Parent/Guardian if under 18):

Date:

I hereby grant Youth Initiative Mentoring Academies/Youth Initiative Aviation Academy and its agents and assigns the right and per-mission to use of my sons daughter’s name and reproduction of physical likeness for the purpose of publicizing the program through the pamphlets, video, newspaper, periodicals, etc.
Registrant’s Signature (or Parent/Guardian if under 18):	Date:

You acknowledge that instruction and training in the flight academy is physically strenuous and involves the risk of injury. You rep-resent that you are physically fit to undertake our training activities. You agree that all activities and the use of our facilities are at your own risk and that we, our instructors and our other students will not be liable for any claims, demands, injuries, damages, or actions resulting from your use of our services and facilities. You also agree not to sue us, our instructors and other employees for any injury or loss resulting from the use of our services and facilities. There is no health insurance or medical coverage provided by this program. The signing of this form acknowledges that the students parent/guardian accepts responsibility for payment of any medical treatment which may be required while they are in the program.
Registrant’s Signature (or Parent/Guardian if under 18):	Date:
Signature of School Counselor (if enrolled in K-12 school): Not Applicable	Date: NA
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ADDITIONAL FORMS

YIMA Pre-Evaluation

Youth Initiative Mentoring Academic (YIMA) - Pre Course Evaluation

Please complete all the following items/questions as honestly and directly as possible.
YIMA will use your responses to assist in making modifications and improvements to the program.

Last Name:

First Name:

Middle Name:

Date of Birth:

Age:

Gender:

1.	How would you rate your knowledge of mathematics (through fractions, decimals, etc?
2.	What is your attitude toward solving mathematical problems?
3.	Your comfort level in *reading* and understanding technical material?
4.	Attitude toward having to read and study technical material?

5.	Comfort level when speaking before an audience?
6.	Ability to meet and establish positive relationships with new people in my age group?
7.	Skills and abilities to solve conflicts with others in a non-violent way?
8.	Skills/ability to get others to accept you as their leader?
9.	Ability to work as a team member, follow instructions and sharing responsibilities?
10.	Willingness and skills to reach out, encourage and assist others who may not understand what they are assigned to accomplish?

In general, what is your attitude about having to relate with:

11.	Teachers/educators?
12.	Preachers/clergy?
13.	Police officers?
14.	Medical staff?
15.	Most adults in authority?
16.	How comfortable are you in relating with adults (other than your parents, aunts, uncles, etc.)? YOUTH/ADOLESCENTS ONLY
	How comfortable are you in relating with youth/adolescents (other than your children, nephews, nieces, etc.)? ADULTS ONLY
17.	How easy is it for you to work closely with adults in problems and cooperating with them? YOUTH/ADOLESCENTS ONLY
	How easy is it for you to work closely with youth/adolescents in problems and cooperating with them? ADULTS ONLY

How would you rate your PRESENT/CURRENT knowledge of:

18.	The aviation industry?
19.	The instruments used in flying an airplane?
20.	The way airports and runways are operated?
21.	The many career/job opportunities in the area of aviation?

What is your attitude concerning:

22.	Your using drugs?
23.	The instruments used in flying an airplane?
24.	Your associating with street gangs?
25.	Your attending school?
26.	Your being expected to obey authority?

27.	How important is it for you to successfully complete this YIMA program?
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YIMA Post Evaluation

Youth Initiative Mentoring Academic (YIMA) - Post Course Evaluation

Please complete all the following items/questions as honestly and directly as possible.
YIMA will use your responses to assist in making modifications and improvements to the program.

Last Name:

First Name:

Middle Name:

Date of Birth:

Age:

Gender:

1.	How would you rate your knowledge of mathematics (through fractions, decimals, etc)?
2.	What is your attitude toward solving mathematical problems?
3.	Your comfort level in *reading* and understanding technical material?
4.	Attitude toward having to read and study technical material?

5.	Comfort level when speaking before an audience?
6.	Ability to meet and establish positive relationships with new people in my age group?
7.	Skills and abilities to solve conflicts with others in a non-violent way?
8.	Skills/ability to get others to accept you as their leader?
9.	Ability to work as a team member, follow instructions and sharing responsibilities?
10.	Willingness and skills to reach out, encourage and assist others who may not understand what they are assigned to accomplish?

In general, what is your attitude about having to relate with:

11.	Teachers/educators?
12.	Preachers/clergy?
13.	Police officers?
14.	Medical staff?
15.	Most adults in authority?
16.	How comfortable are you in relating with adults (other than your parents, aunts, uncles, etc.)? YOUTH/ADOLESCENTS ONLY
	How comfortable are you in relating with youth/adolescents (other than your children, nephews, nieces, etc.)? ADULTS ONLY
17.	How easy is it for you to work closely with adults in problems and cooperating with them? YOUTH/ADOLESCENTS ONLY
	How easy is it for you to work closely with youth/adolescents in problems and cooperating with them? ADULTS ONLY

How would you rate your PRESENT/CURRENT knowledge of:

18.	The aviation industry?
19.	The instruments used in flying an airplane?
20.	The way airports and runways are operated?
21.	The many career/job opportunities in the area of aviation?

What is your attitude concerning:

22.	Your using drugs?
23.	The instruments used in flying an airplane?
24.	Your associating with street gangs?
25.	Your attending school?
26.	Your being expected to obey authority?

27.	How important is it for you to successfully complete this YIMA program?

28.	How interesting was the YIMA Program?
29.	How helpful was the program?

30.	Would you recommend that other people in your age group enroll in the program?
31.	Any other comments (recommendations for change, etc.)
	Please write any comments here.
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YIMA Weekly Critque Form

Youth Initiative Mentoring Academic (YIMA) - Post Course Evaluation

Please complete all the following items/questions as honestly and directly as possible.
YIMA will use your responses to assist in making modifications and improvements to the program.

Last Name:

First Name:

Middle Name:

Week of:	Topic/Each Day:
Tuesday:	Thursday:	Saturday:

1.	Rate the instructor:
2.	Explain reason(s) for your rating:

3.	Mentor:
4.	Rate relations with mentor:
5.	Explain reason(s) for your rating:
6.	Activites:
7.	Discussion Topics:

8.	Protege:
9.	Rate relations with protege:
10.	Explain reason(s) for your rating:
11.	Activites:
12.	Discussion Topics:

Field Trip

13.	Destination:
14.	Rate the trip:
15.	Explain reason(s) for your rating:

16.	What was learned/experienced:
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Mentoring

Application & Reg Forms

History

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Home

About Us

Contact Us

News and Events

Photo Album

Mentoring

Application & Reg Forms

History

Testimonials

Links & Videos

Application & Registration Forms

Downloadable Registration Forms