2019 L.E.A.D Academy Registration
Please fill out this application in its entirety and submit for review by Monday, January 21, 2019.

Contact us at MuPsiLambda@hotmail.com if you have any questions.

Participant Information
Please enter participant information.
First Name *
Your answer
Middle Initial
Your answer
Last Name *
Your answer
Home Address *
Your answer
City *
Your answer
State *
Zip Code *
Your answer
Age *
Your answer
Dietary Restrictions *
Phone Number *
Please enter in the format of 205-555-5555
Your answer
Email *
Your answer
Education Information
Please enter education information for the participant.
School *
Your answer
Classification *
GPA *
Parent/Guardian Information
Please enter parent/guardian information.
First Name *
Your answer
Middle Initial
Your answer
Last Name *
Your answer
Relationship to Participant *
Your answer
Phone Number *
Please enter in the format of 205-555-5555
Your answer
Email *
Your answer
Questionnaire
Please answer the below questions in clarity.
In no more than 150 words, define what leadership means to you. *
Your answer
List three (3) extra-curricular activities that you are involved in and what role you play in them. *
Your answer
List three (3) careers and/or college majors that you might be interested in pursing. *
Your answer
Agreements
Please read and agree to the terms below to certify and satisfy requirements for your registration submission and program participation.
By submitting this application, I agree that (if accepted into the program) I will take initiative, act in a mature/professional manner, and be respectful of time commitments. *
Required
I understand that I can not be absent from more than two (2) sessions in order to graduate from the academy. *
Required
I understand that I will have to pay $45.00 registration fee before the deadline of Monday, January 21, 2019. *
Required
I understand that I will have to participate in raising a minimum of $250.00 in ads for the Souvenir Book provided at the completion of the academy. *
Required
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service