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Global Leadership Program Fall 2018 Application Form / Pearl S. Buck International
Greetings, and thank you for your interest in becoming a student with our Fall 2018 Global Leadership Program. Applications will be reviewed and processed in the order they are received. The deadline for this application has be extended to Tuesday, September 25, 2018. Interviews will be scheduled with all applicants who submit complete applications by the deadline.

If you have any questions, contact Alyssa Davis at ADavis@pearlsbuck.org or 215-249-0100, ext. 116.

Last name: *
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First name: *
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Middle name: *
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Birth date: *
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Address: *
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Phone number (home): *
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Phone number (cell): *
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Email address: *
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Parent/Guardian name: *
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Parent/Guardian phone number: *
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Parent/Guardian email address: *
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Emergency contact (not listed as your Parent Guardian above) information - name/relationship /phone number (e.g., Alice Berry/Aunt/555-5555)
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Education - Current high school: *
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Education - Current grade level: *
What are your favorite subjects in school? *
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List any extracurricular activities. *
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List any job experience (paid or volunteer) and briefly describe your responsibilities. *
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Do you currently have a part-time job? If so, how many hours per week do you work? *
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Please list up to five activities, clubs, organizations, or teams in which you have participated during the last two years. (e.g., Mock Trial Club - 2 years; Reading Olympics - 3 years; Band - 5 years; Mathletes - 1 year) *
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List any special awards, honors, or other information related to your involvement with activities and/or organizations. *
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Describe yourself, using a few phrases or adjectives. *
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What do you hope to get out of this program? *
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Essay question #1 (250 words or less) If you could improve anything in your community, what would it be and how would you improve it? *
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Essay question #2 (250 words or less) Give an example of a time when you played a leadership role in an event, activity or other situation. Describe how you led and how others responded to your leadership. *
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Commitment - Each participant is expected to attend every session. To make sure you do not have unavoidable conflicts, please compare your schedule with the program dates before submitting your application. If selected, you must commit to attend all program sessions. including the service-project activity. Please initial that you have read and agree with this: *
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Please sign and date your application below: *
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