MYLP Student Application

Student Commitment

Please check the box next to each statement showing that you agree to comply with these rules if accepted.

Consent*

I will attend the required orientation with my parent or guardian.

Consent*

I will submit a $200 non-refundable deposit fee along with required waiver forms (which will be sent to those who have been accepted) by the designated due date.

Consent*

I agree to attend the regular scheduled phone or online check-in meetings with my advisor in preparation to MYLP.

Consent*

I understand program participants are not expected to pay for the costs out of pocket, but they are required to work with their advisor and local CAIR-CA office to fundraise before the program.

Consent*

I will not use or have my cell phone on hand throughout MYLP. (Participants are allowed to bring cell phones but are required to leave them in a safe in their hotel room. Participants will be allowed to communicate with their parent/guardian in the mornings and evenings prior to the start and after the end of each day.)

Applicant Information

Name*

First Last

Gender*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Cell Number*

Email*

Parent or Guardian Name*

First Last

Parent or Guardian Cell Number*

Parent or Guardian Email*

Ethnicity*

Date of Birth*

Name of educational institution you currently attending*

Address of School*

What school districts have you attended?*

Is English your first language?*

Yes
No

Which region/office is closest to you?*

Which masjid do you attend?*

Select your class standing as of Fall 2025*

Sophomore
Junior
Senior
Freshman in college

Date of high school graduation*

School Counselor/Teacher Name (Note: This person might be contacted as a reference.)*

Counselor/Teacher Phone Number*

Do you have any dietary restrictions?*

If yes, please specify. If no, state no.

Are there any medical condition(s) that CAIR-CA staff/advisors need to be aware of?*

If yes, please list condition(s) and any possible medication that the student will be bringing. If no, state no.

Do you acknowledge that you will bring your own medications?*

Yes
No

Do you acknowledge that CAIR-CA can provide over the counter medication when you're not feeling well?*

Yes
No

T-shirt Adult Size*

How did you hear about MYLP? (Check all that apply.)*

Short Answer Questions

Why do you want to participate in CAIR-CA's Muslim Youth Leadership Program? What do you hope to gain from this experience? (150 words max.)*

Please summarize your involvement in community organizations (faith-based and secular). For all volunteer and paid roles, please list and explain the position(s) held, date(s) in position, and hours worked per week. (150 words max.)*

Essay Questions

What event has had a lasting impact on your life and how has it changed your view of the world and your role in it? Note: Think about a challenging obstacle you have had to overcome, or a moment of triumph that you have experienced. (500 words max.)*

Please research a CURRENT and SPECIFIC government policy at the city, county, state or federal level. What would you change about this policy? Why do you think the change is necessary? Please cite sources using in-text citation. (500 words max.)*

MYLP Student Application

Please read the instructions below before completing the application.

2024 MYLP Student Application

Student Commitment

Applicant Information

Short Answer Questions

Essay Questions