20/20 Leadership Program Application 2018 - 2019 20/20 Leadership Program Application 2018 - 2019 20/20 Status*New StudentReturning Student2018 – 2019 Grade Level*FreshmanSophomoreJuniorSeniorBirthdate*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*School*Student Email* Student ID #Current GPA*Please list any employment and civic, professional, religious, community, athletic, social or other organizations that you currently participate in.*What was your favorite program day experience and why?*How did you learn of 20/20 Leadership?*What are your goals after graduating from high school? How do you expect that 20/20 Leadership can help you achieve those goals?*APPLICANT COMMITMENTI understand that, if I am selected as a participant in 20/20 Leadership, attendance is required when regular leadership meetings take place, and I am willing to attend the functions sponsored by the program. As a member of the organization, and as a future alumnus, I accept responsibility for my actions and will represent myself, family and 20/20 Leadership in an appropriate, polite and respectful manner. I will not engage in bullying, harassing or discriminating behavior. I understand that if I fail to meet any part of the obligations of participating, I may be asked to withdraw from the program. I hereby certify that the information provided above is complete and correct. This iframe contains the logic required to handle Ajax powered Gravity Forms.