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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.
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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
*
Choose
AL
Zip Code
*
Your answer
Age
*
Your answer
Phone Number
*
Please enter in the format of 205-555-5555
Your answer
Email
*
Your answer
T-Shirt Size
S - Small
M - Medium
L - Large
XL - Extra Large
XXL - 2 Extra Large
XXXL - 3 Extra Large
Clear selection
Dietary Restrictions
*
None
Vegetarian
Vegan
Kosher
Gluten-free
Other:
Education Information
Please enter education information for the participant.
School
*
Your answer
Classification
*
Freshman
Sophomore
Junior
Senior
GPA
*
Choose
4.0 or above
3.5 - 3.9
3.0 - 3.49
2.5 - 2.9
Below 2.5
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.
Why do you want to be apart of the Alpha L.E.A.D. Academy? (150 words or less)
*
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.
*
Agree
Disagree
Required
I understand that I can not be absent from more than two (2) sessions in order to graduate from the academy.
*
Agree
Disagree
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
*
Agree
Disagree
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.
*
Agree
Disagree
Required
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