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Lead UC Youth Application

Please complete each section in full.
Applications may also be typed or handwritten and submitted to:
Lead UC Youth Program
208 W. Taylor, P.O. Box 471
Creston, IA 50801

For an Application Tutorial, click here.


  1. The student must complete and submit SECTION I-STUDENT INFORMATION.
  2. The adult/peer reference must complete and submit SECTION II-REFERENCE INFORMATION. The adult/peer reference should be an individual that is personally acquainted with the student, and will continue to have contact with the student throughout the next school year. The reference should not be a family member of the student. This form can be used to nominate a student for the program.

If you have any questions regarding the Application or Reference Form, please contact:

Mindy Stalker, Program Coordinator 641-782-2003

Due Date: The application period is now open for the Class of 2019! Applications are due May 1, 2018.

PDF Version of the application can be found here HLYL App