LEAD Academy Application

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As a Purdue Northwest student, the same professional leadership development program that community and business leaders pay thousands of dollars for is now available to you... for FREE! The LEAD Academy is a customized leadership program designed exclusively for PNW students to guide you on your leadership journey. The program includes leadership development, training and networking with peers!

Contact Information

Please use the most current information to tell us more about yourself.

First Name *

Last Name

Date of Birth *

YYYY

Mobile Number *

PNW Email Address *

Please select your t-shirt size *

XXL

Mailing Address ( House Number, Street, City, State, Zip Code) *

Which PNW Campus do you attend? *

PNW Westville Campus

PNW Hammond Campus

Education

Please indicate the following as accurately as possible.

Major *

Classification *

Freshman

Sophomore

Junior

Senior

Graduate Student

Anticipated graduation date

YYYY

List any University Affiliations (i.e. TRIO, Honors College, Clubs, etc. )

Scholar Information

This section helps us understand you as a valued PNW student on a more personal level. Please complete to the best of your knowledge.

Student ID

Please share a self assessment of your personal academic confidence:

Below Average

Excellent

Clear selection

Please share a self assessment of your personal leadership ability:

Below Average

Excellent

Clear selection

Please share a self assessment of your work ethic:

Below Average

Excellent

Clear selection

Please share a self assessment of your time management skills:

Below Average

Excellent

Clear selection

Please share a self assessment of your academic ability:

Below Average

Excellent

Clear selection

Please list your personal strengths:

Please list areas you feel you can improve:

How beneficial do you think this program will be to you? *

Not at all

Very

Please understand that this program is designed to offer PNW students valuable leadership development that can be used on and off campus in multiple areas of life. At the completion of the 4 week program, participants who have attended at least 3 of the 4 sessions will receive a certificate and gift from The Leadership Institute at PNW.

Do you agree to attend at least 3 sessions? By clicking yes, you understand that if you do not attend at least 3 sessions, you will not receive a certificate of completion.

Yes, I understand and agree to the attendance requirements.

E-Signature *

Submit

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