Application Form | The Impact and Research Fellowship by Harvard Student Agencies
Start Date: 9th June 2024
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Full Name *
Student Email Address *
Student Mobile Number *
State / Province *
Country *
School Name *
Currently studying in Grade: *
Parent/ Guardian Name *
Parent/ Guardian Mobile Number *
Parent/ Guardian Email Address *
School Counsellor/ Principal Name *
School Counsellor/ Principal Email Address *
Which research theme are you interested in? Select any 3 (details on the program page) *
Preference 1
Preference 2
Preference 3
STEM
Arts & Humanities
Law
Business/Entrepreneurship
Which 'Passion Project' theme are you interested in? Select any 3. (details on the program page) *
Preference 1
Preference 2
Preference 3
STEM
Community Services
Arts
Business
How did you get to know about the program? *
Scholarship Code
Undertaking and consent by form users:-
I hereby confirm that the information provided in this form is true and correct. The application will be processed based on the details provided.

Learn with Leaders reserves the right to use this information to correspond regarding current and future programs. Right to admissions reserved.
____________________
I understand that participation in the program implies the student to be included in the documentation of the program, including photographs, audio/video recordings, reproductions of academic work and verbal descriptions/quotations of program content.
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