You must have JavaScript enabled to use this form. Application Container Section I - Applicant Information First Name (Please use full legal name) Last Name(s) Phone Number Email Who does this phone number belong to? Applicant Parent or Guardian Other… If other, please specify: Residential Address Residential Address City/Town ZIP/Postal Code Age and Enrollment Confirmation * I confirm that I am currently enrolled in high school during the 2025–2026 academic year. Section II - School Information Full Name of School Grade Level (During the 2025–2026 Academic Year) Residential Address Residential Address City/Town ZIP/Postal Code Section III - Parent or Guardian Information Parent or Guardian Name Parent or Guardian Phone Number Phone Number Parent or Guardian Email Address Email Parent or Guardian Consent * By checking this box, the parent or guardian acknowledges that the student is applying to participate in the Young Legislator Program hosted by the Office of Senator Anna Caballero and supports their participation if selected. Section IV - Emergency Contact Emergency Contact Phone Number Emergency Contact Relationship Section V - Program Logistics Unisex T-Shirt Size XS S M L XL XXL Do you have any dietary restrictions or food allergies our office should be aware of? * No Yes Please specify Do you require any accommodations to fully participate in this program? No Yes Please describe I may need assistance accessing broadband or technology to participate in virtual sessions. Section VI - Short Response Questions (Please respond in 50 words or more.) Why are you interested in participating in the Young Legislator Program? What do you hope to learn or gain from the experience? What is one issue facing your community, California, or the country that you care about? Why does this issue matter to you? If you had the opportunity to improve one thing in your community, what would it be and what steps would you take to address it? Leadership or Community Involvement (Optional) Describe a time when you demonstrated leadership, helped others, or became involved in your school or community. What did you learn from that experience? Section VII - Program Acknowledgments and Agreements Participation and Conduct Agreement * By checking this box, I acknowledge and agree to the following:If selected, I will make every effort to attend all scheduled program sessions.Participants who miss multiple sessions without prior communication may forfeit their place in the program.Program sessions and activities may be subject to change.The Office of Senator Anna Caballero may modify, reschedule, or cancel program activities if necessary.Participants are expected to behave respectfully and follow instructions provided by program staff.Participants whose conduct disrupts the program or violates program expectations may be removed from the program.Program activities may take place in government facilities, including the California State Capitol, and participants must follow all security procedures and facility rules.Transportation for certain activities may be coordinated by the Office of Senator Anna Caballero and participants must follow all instructions provided during travel or program activities.Photographs or video may be taken during program activities and may be used for official program materials or communications.Participation in the Young Legislator Program is voluntary and does not constitute employment with the State of California or the Office of Senator Anna Caballero. Section VIII - Additional Confirmations Eligibility Confirmation * I confirm that I live in or attend school within Senate District 14. Communication Responsibility * I understand that important program updates will be sent to the email address provided in this application. Certification of Information * I certify that the information provided in this application is accurate to the best of my knowledge. Program Participation Understanding * I understand that participation in the Young Legislator Program is limited and that selection decisions and participation determinations are made at the discretion of the Office of Senator Anna Caballero. Student Responsibility Statement * If selected, I agree to participate respectfully and represent my school and community in a positive manner. Waiver Requirement Acknowledgment * If selected, I understand that participation in the Young Legislator Program will require submission of signed permission and release forms from a parent or guardian before participating in program activities. Electronic Signature (Applicant Name) Date Photo Upload Upload portrait image.One file only.5 MB limit.Allowed types: jpg, jpeg, png.
