Global Leadership Certificate Application
Thank you for your interest in the World Affairs Council's Global Leadership Certificate!

To be officially accepted into the Certificate program, students must complete the following application. Please note, a parent/guardian is required to sign the Certificate Terms Agreement, Liability Release, and Media Waiver.

Please download the Certificate Terms Agreement, Liability Release, and Media Waiver at https://tinyurl.com/GLCForms.

To submit this document, please scan or take a photograph and upload the file(s) at the end of the form. You can also mail a signed copy to:
World Affairs Council of Pittsburgh
c/o Kathleen Newell
2640 BNY Mellon Center
500 Grant Street
Pittsburgh, PA 15219

After you submit this application, you will receive a confirmation e-mail from the World Affairs Council within a few days.

If you have any questions concerning the Global Leadership Certificate, please contact Annie Prucey or Kathleen Newell at certificate@worldpittsburgh.org or 412-281-7970. Thanks!

Email address *
First Name *
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Last Name *
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Your Email Address *
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Cell Phone Number *
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Street Address *
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Street Address Line 2
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City *
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State *
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Zip Code *
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Date of Birth *
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Age *
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Pronouns *
School Name *
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Grade during the 2019-2020 School Year *
Please describe your race/ethnicity (Select all that apply). *
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Current Grade Point Average *
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Name of Teacher Sponsor *
A teacher sponsor is a teacher at your school who can advise you as you complete the Certificate. Your teacher sponsor will receive information on upcoming Council events and will help you as you design and implement your service-learning project. Most often teacher sponsors are social studies or world language teachers (but you can select any teacher).
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Teach Sponsor Email Address *
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Name of Parent/Guardian *
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Parent/Guardian Email Address *
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Parent/Guardian Telephone Number *
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World Language Course and Level *
Ex. French II
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Please list all high school Social Studies classes taken (including current) *
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Do you currently have a Schoology account? (Schoology is a learning management system, similar to Blackboard, Google Classroom, etc.) *
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