LEAD Course Application Form

Lead Course Applicant Info

Full Name

Mobile Number

Email Address

Date of Birth

Home Number

Facebook Profile

Permanent address

Temporary Address

Same as Permanent Address

Three words that describe who you are

Do you plan to apply for a scholarship?

Yes - Full

Yes - Partial

Education Background Info

College Name

+2 Faculty

College Address

If accepted, my parent/guardian has given me permission to participate in the 2021-2022 LEAD Course

Yes

Guardian’s Contact Info

Parent's/Guardian's Full Name

Parent's/Guardian's Phone Number

Relation to the Applicant

Essay Questions

Do you think of yourself as a leader? Why or why not? What are your personal strengths?

What issues in your community and/or college do you care about, and what makes you feel so strongly about that specific problem?

How important is your ethnic background when you think about creating change in your community? Tell us about your hopes and dreams; for yourself, your community and your country?

Survey

Media Release

I give Women LEAD permission to photograph, film, or otherwise record in picture and/or sound my experience/expectation/view during and/or after the program. I hereby consent to the use of any recordings on Women LEAD websites and promotional materials, in print and other media. I authorize Women LEAD to reuse, copy, publish, display, exhibit, reproduce and distribute these materials. All recorded media, prints and created media from the content shall constitute the property of Women LEAD and I will not receive any payment from Women LEAD as a result of any publication of the material. I release Women LEAD from any and all claims arising out of any use of my images and recordings.

I agree