Apply to High School Leadership Montezuma

High School Leadership Montezuma Application

Application to High School Leadership Montezuma takes around 20-30 minutes. If you have any questions or issues when applying, please contact Alex Prime, Program Coordinator, at (970) 274-4037.

Applicant Information
Name
FirstLast
Email
Home Phone
Cell Phone
Address
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
Gender
- Male
- Female
Date of Birth
Parent/Guardian Information
Name
FirstLast
Email
Please provide us with the email address of a parent/guardian that we may communicate with on a monthly basis.
Are the phone & address the same as the applicant?
- Yes, same Phone & Address
Address
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
Phone
Full attendance by each participant is essential.
School attendance credit will be granted for each session attended.
Signature of Applicant*
I willingly commit to attending each of the program sessions throughout the 2011-2012 school year.
Signature of Parent or Guardian*

Diet & Health
Do you have any special dietary needs of which we should be aware?
- I have special dietary needs
Tell us what we can provide for your dietary needs.
Do you have any special health concerns we can help accommodate in order for you to attend?
- Yes, I have health concerns
Tell us where we can help with your health concerns.
Emergency Contacts
List below two people we can call during the day in case of a health emergency.
Name of Emergency Contact #1
Phone Number of Emergency Contact #1
Name of Emergency Contact #2
Phone Number of Emergency Contact #2

Think of someone who has impacted your life or influenced you in some way. What are the leadership qualities that person possessed?
Please describe how you would like to make a difference in your community.
What are your hobbies?
Describe your extra-curricular activities.
What extra-curricular activities (both school and community) are you involved in? What months do these activities occur? When do these activities occur (during the school day, right after school, evening, weekend, etc.)? Please provide a schedule if you have one.
What is the best way for us to communicate with you?
- Home Phone
- Cell Phone
- Facebook
- Email
- Other
The best way to contact you is:
Comments
This field is for validation purposes and should be left unchanged.

SCLC

Apply to High School Leadership Montezuma

High School Leadership Montezuma Application

Step 1 of 3

Applicant Information

Parent/Guardian Information

Full attendance by each participant is essential.

Diet & Health

Emergency Contacts

Upcoming SCLC Events

SCLC

Apply to High School Leadership Montezuma

High School Leadership Montezuma Application

Step 1 of 3

Applicant Information

Parent/Guardian Information

Full attendance by each participant is essential.

Diet & Health

Emergency Contacts

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Upcoming SCLC Events