2019 Missouri Leadership Seminar Student Nomination Form
Please note you will not be able to save information and return to the form. Please have all required information available before beginning.

Information collected through this nomination process is used for the express purpose of facilitating the Registration process and for future communications for the 2019 Missouri Leadership Seminar.

At no time will any information collected through this system be transferred or sold to a 3rd party organization.
School Information
Please update your school information for our records.
School Name *
Your answer
School Mailing Address *
Your answer
School City *
Your answer
School State *
School Zip Code *
Your answer
School County *
Your answer
School Main Phone *
(999-999-9999)
Your answer
School Principal
Your answer
School Contact Information
Please update your School Contact Information. Future correspondence will be sent to the contact listed. This includes Registration Information and Student Information Packets for the 2019 MLS, as well as the call letter for the 2020 MLS.
School Contact First Name *
Your answer
School Contact Last Name *
Your answer
School Contact Email Address *
Important MLS information and updates will be sent to this email address.
Your answer
School Contact Phone Number *
(999)999-9999
Your answer
Tentative Last Day of School *
MM
/
DD
/
YYYY
Tentative Last Day School Contact Can Be Reached *
MM
/
DD
/
YYYY
What type of Nomination is this? *
Primary Student Nomination Information
Please enter information for your primary nominee. Schools are permitted to nominate one current sophomore student.
Student Gender *
Student First Name *
Your answer
Student Last Name *
Your answer
Student Preferred Name (if different)
(Will instead of William)
Your answer
Student Phone Number *
(999) 999-9999
Your answer
Can the student receive text messages?
Students will have the option to opt in to text message alerts, if interested
Student Alternate Phone Number
(999)999-9999
Your answer
Student Email Address
Important pre-seminar information and updates will be sent to this email address. If this email is a school email, please make sure it can receive outside emails.
Your answer
Is this student a current sophomore? *
Parent/Guardian Name(s)
Your answer
Parent/Guardian Relation
Your answer
Parent/Guardian Phone Number
(999) 999-9999
Your answer
Alternate Student Information
Please select an alternate student to attend MLS if your primary nominee is unable to attend. The alternate student is not required to submit any further information unless the primary student is unable to attend.
Alternate Student First Name
Your answer
Alternate Student Last Name
Your answer
Alternate Student Phone Number
(999) 999-9999
Your answer
Alternate Student Email Address
Your answer
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