Compassionate Leaders Program Registration - 2014 Fall
This application is to be filled out by the student who intends to apply. We see the completion of this application as a gesture of a student's genuine interest to participate in the program. For this reason, we ask that parents only assist in it's completion. If you are a parent and have questions about the program, we'd love to talk with you. You can contact Jeff at (858-692-5473)


If you have any questions regarding this application, please contact us: jeff@compassionateleaders.org
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1. Student Contact Information *
First
Last *
City *
Email *
Phone Number *
2. Date of Birth *
MM
/
DD
/
YYYY
3. Name of your learning community/small school at BHS *
4. Your Grade *
5. Contact Info For Parent/Guardian *
Name
Parent/Guardian Email *
Phone *
6. How did you hear about the program? *
7. Please tell us why you are interested in being in this program? *
8. Tell us a little bit about who you are. What are your strengths and what are the areas in your life you wish to grow and learn into. Why? *
Which day are you available after school to attend our weekly sessions from 3:45-5:45? *
Required
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