Online Application Form

Biographical Information

Last Name*  
First Name*  
Street Address*  
City*  
State*  
Zip Code*  
E-mail Address*  
Phone Number*  
Academic Standing (e.g. 3.0 on a 4.0 scale)*  

If you have also applied to other Service Learning Teams here at SC, please check them below:
Discipleship Southwestern
Green Team Southwestern

List three issues or areas of interest which you would like to explore during the Leadership program:

Personal Statement

Briefly describe yourself and your background:

How do you expect to benefit from this program?

How have you demonstrated your leadership ability and/or initiative?

Choose a local, national, or international problem that is of interest to you. Explain why the issue is important to you and how you would address the situation if you were involved in it in a leadership position:

Please list any extracurricular and/or community activities in which you are involved:

List any honors and/or awards you have received:

List, in chronological order beginning with the most recent, any work experience you have had:

Please include volunteer work and military:

References

As part of your application process, you will need to provide two references. List each reference below. Once you submit this form, you will be given a link to an online Reference Form to share with each reference for them to fill out. Please list employers, teachers/professors, pastors or any other organization leaders for your references. Note:  References cannot be family members.

First Reference Information:

Name


Relationship


Email

Second Reference Information:

Name


Relationship


Email

Signature

Waiver of Access: I have requested that this recommendation be filed for use in the selection process for the Leadership Southwestern team. In accordance with the Family Rights and Privacy Act of 1974, I have indicated my intention regarding access to this recommendation by checking one of the following options:

I waive access to this recommendation which shall therefore be considered confidential.
I do not waive access to this recommendation.

By typing my name in the Signature textbox below and submitting this online form I certify under penalty of perjury that all information provided is correct and complete. I understand that my application is not valid if I have knowingly falsified information.

Signature

Date