2021 L.E.A.D Academy Registration
Please fill out this application in its entirety and submit for review by Monday, January 18, 2021.

Contact us at MuPsiLambda@hotmail.com if you have any questions.
Participant Information
Please enter participant information.
First Name *
Middle Initial
Last Name *
Home Address *
City *
State *
Zip Code *
Age *
Phone Number *
Please enter in the format of 205-555-5555
Email *
T-Shirt Size
Clear selection
Dietary Restrictions *
Education Information
Please enter education information for the participant.
School *
Classification *
GPA *
Parent/Guardian Information
Please enter parent/guardian information.
First Name *
Middle Initial
Last Name *
Relationship to Participant *
Phone Number *
Please enter in the format of 205-555-5555
Email *
Questionnaire
Please answer the below questions in clarity.
Why do you want to be apart of the Alpha L.E.A.D. Academy? (150 words or less) *
List three (3) extra-curricular activities that you are involved in and what role you play in them. *
List three (3) careers and/or college majors that you might be interested in pursing. *
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 $35.00 registration fee before the specified deadline. https://www.paypal.com/cgi-bin/webscr?cmd=_s-xclick&hosted_button_id=7DUXUCWML7KH6 *
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
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