Central Wisconsin High School Leadership Program Online Application

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Online Application

A total of 40-45 students will be selected into the program. Students will be notified by August 15 of their acceptance. After the student is notified, the tuition payment will be requested to secure the student’s place in the program. The information provided below will be used solely for program evaluation and program eligibility purposes and will be kept confidential.

I. Personal Data

First Name: *

Last Name: *

Birth Date: *

YYYY

Gender: *

Female

Male

Other:

T-shirt Size: *

Small

Medium

Large

X Large

Race/Ethnicity: *

White

Hispanic or Latino

Black or African American

Native American or American Indian

Asian / Pacific Islander/Hmong/Laotian

Other:

Year of Graduation: *

Student's Mobile Phone: *

Street Address: *

City: *

Zip: *

Student's Email Address: *

School student is attending: *

DC Everest

Marathon

Mosinee

Newman

Northland Lutheran

Wausau East

Wausau West

II. Student Primary Parent or Guardian Contact Information

First Name: *

Last Name: *

Relationship to Student: *

Mother

Father

Guardian

Other:

Street Address: *

City: *

Zip: *

Mobile Phone: *

Work Phone Number: *

Email: *

III. Essay Questions - Students please respond to the following questions:

What is your opinion of civic engagement or community service as it relates to leadership and how will you use the leadership skills learned in this program to increase your own involvement in your school and community? *

List below any clubs or organizations that you belong to in school, church, or the community: *

Please share why you may not have not been as active in community, civic, or school activities as you would like to be? *

IV. Scholarship Opportunity

Scholarships are available to students who may find it difficult to pay the $250 participation fee due to financial difficulties. If you are interested in being considered for a scholarship, please complete the information below. If you are not interested in applying for a scholarship, please skip a-e. All approved scholarship recipients will be required to pay a fee of $25.

Has your primary parent listed in the application earned a bachelor’s degree from a four-year university or college? *

Yes

Has your other parent earned a bachelor’s degree from a four-year university or college? *

Yes

Does your family qualify for or receive free or reduced priced meals at school? *

Yes

Does your family qualify for or receive any other forms of state or federal support (TANF, food stamps, etc.)? *

Yes

Due to your family financial circumstances, I would like to be considered for a scholarship to attend this program? *

Yes

V. Student Commitment:

I understand the purpose of the Central Wisconsin High School Leadership program and if I am selected, will devote the time and energy necessary to complete the program. Even though emergencies do arise, I understand any participant missing more than one session, for whatever reason, will be asked to withdraw from the program and no portion of the tuition will be refunded. Please check yes if you agree. *

Yes, I understand the above commitment and agree to this by submitting this application.

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