Leadership Jacksonville

Collegiate Leadership Experience Application Form

Please submit completed application by Friday, February 29, 2008.

Please e-mail a picture (headshot preferable) to meg@leadershipjax.org by February 29, 2008.

During the process of completing this form, should you want to save your form and continue later, please enter your email below and click "Save". A password will be sent to your email to be used in conjunction with your email in order to retrieve saved form data.

Email:

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Personal Information
First Name
Last Name

Name Called
Gender
Date of Birth

College/University
College Semesters Completed (as of June '07)
Major

Preferred Mailing Address
City
State
Zip

E-Mail
Phone
Alternate Phone

Recognitions

List awards, honors, or recognitions for academic, school, or community related activities you have received over the last three years (use space below only):

Organizations and Activities

Please list activities or organizations in which you have participated during the last three years:

Work Experience

List any job experience and briefly tell what it involved:

Considering that there are many applicants for this leadership program, what two or three things do you most want us to know about you?

Each of us has different skills, talents and experiences. What do you offer to the class?

Interview Preference

Please check the days you would be available for a 20 minute interview over the phone:

2008 Interview Dates

Saturday, March 15th 9:00 am - 2:00 pm Yes No	Monday, March 17th 4:00 pm - 9:00 pm Yes No
Tuesday, March 25th 4:00 pm - 9:00 pm Yes No	Thursday, March 27th 4:00 pm - 9:00 pm Yes No
Saturday, March 29st 9:00 am - 2:00 pm Yes No	Tuesday, April 1st 4:00 pm - 8:00 pm Yes No

Once your application is complete and accurate, click the submit button to submit your application.

NOTE: The form may take a little while to process after you hit the submit button. Please be patient.