Live Learn Leadership Program Application

Women’s Leadership: South Africa 2020

Students must complete the entire application including essay question and photo submission. Student and parent(s) must also review, sign and submit the program Agreement and Release Form as directed after submission of the application.

Participant

Last Name *

First Name *

Middle Name

Address *

City *

State *

Zip *

Home Telephone *

Participant Cell

Date of Birth *

Sex *

Male

Female

Are you a U.S. citizen? *

Yes

No

OtherOther

Do you have a U.S. Passport? *

Yes

No

Parent/Guardian

First Name *

Last Name *

Relationship *

Email *

Phone *

Home Phone

Cell Phone

Phone number best to call *

Home

Cell

Emergency Contact

First Name *

Last Name *

Relationship *

Address *

City *

State *

Zip *

Phone *

This number is a *

Home

Cell

Work

Medical Information

Do you have a special diet, e.g., vegetarian or allergies to certain foods? *

Yes

No

Please specify:

Do you have allergies or chronic ailments of which our Group Leader should be aware? *

Yes

No

Please describe:

Are you receiving medication or any other treatment for any physical or mental condition? *

Yes

No

Please specify:

Photos

Please submit a recent and clear passport/headshot photo.

If you do not have an image available at this time, do not delay in submitting your application. You can send the image separately to: Livelearnleadership@aifs.org. Please include the first name, last name and location in the subject line.

File Upload

Maximum file size: 52.43MB

GPA

Currently enrolled in grade *

Other *

Current GPA *

Essay Question (maximum of 500 words)

Many great leaders are determined and committed to their causes. Write about something that you feel passionately about—and then explain how you could lead others to also care about your cause.

Thank You

Thank you for your request!

Live Learn Leadership

Live Learn Leadership Program Application

Women’s Leadership: South Africa 2020

Participant

Parent/Guardian

Emergency Contact

Medical Information

Photos

GPA

Essay Question (maximum of 500 words)