zMAD Leadership Experience Application
Email address *
This experience has the potential to change you and the community you live in. First, tell us a little about yourself...
Name *
Your answer
Age *
Your answer
Phone number
Your answer
Grade *
School *
Your answer
Counselor, Mentor or Teacher who referred you *
Your answer
Email address of the Counsellor, Mentor or Teacher *
Your answer
Parent or Guardian's full name *
Your answer
Parent or Guardian's contact number *
Your answer
Parent or Guardian's email address
Your answer
List three social/community issues that you would be interested in working on. List them in terms of importance. *
Your answer
What is your greatest strength? *
Your answer
If you could have a superpower, what would it be and why? *
Your answer
List two reasons why you should be admitted into this program? *
Your answer
Do you need transportation to attend the program? *
This program is going to be intense and it is going to ask a lot from you. It runs from June 10th - July 7th , three days a week (Mon, Wed, Fri) from 9:00 am - 12:00 pm. There is a BBQ kickoff meeting on Sat, Jun 10th and the final event is on July 7th at 5:30pm. If you are selected, are you willing to commit to attend all sessions? Please type your name and date. *
Your answer
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