Fillable Center-for-Student-Leadership-Membership-Application Leadership Institute Membership Application

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Center-for-Student-Leadership-Membership-Application Leadership Institute Membership Application

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File type: PDF

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Center for Student Leadership Membership Application
Name:
(Last name/ First name/Middle initial)
Student ID:
Date of Birth: (month/day/year)
Gender: Male Female
Are you a U. S. Citizen? Yes No If no,
(Country of citizenship)
Ethnic Group: (check all that apply)
American Indian or Alaskan Native Asian or Pacific Islander
African American Hispanic/Mexican American/Puerto Rican
Caucasian Other:
(please specify)
Permanen
t Mailin
g
Address:
(Where you receive mail when not in school)
Street Address/PO Box:
City: State: Zip:
School Mailing Address:
(If living on campus and wish to receive mail, please provide P.O. Box)
Street Address/PO Box:
Residence Hall:
City: State: Zip:
Academic Information:
Major: Minor:
Number of Credit Hours:
Indicate Classification:
Sophomore (30-59hours) ____ Junior (60-89hours) ____ Senior (+90 hours) ____
Expected month/year of graduation:
Cumulative GPA (3.0 or higher):
2
Email:
_____________________________________
Academic Achievements, Co-curricular Activities, and Employment
1. College Academic Achievements and Recognition:
Honor societies, professional organizations, academic awards, Dean’s List, etc.
2. Co-curricular Activities:
Do you currently hold leadership positions in community service projects, student
organizations, Greek organizations, Student Government Association, Residence Hall
Association, the Lasso, Student Development, and Orientation Leader etc.?
3. Employment Experience:
List all paid positions within the last 2 years, including any while attending college classes
and/or internships, practicums, student teaching, etc.
3
Short Answer Questions
1. Describe your leadership experiences.
2. Why is it important for you to develop leadership knowledge and skills?
3. What do you expect to contribute to the Center for Student Leadership?
4. How would the Center for Student Leadership support your future goals?
5. Does your department require an internship or practicum(s)? If so, how many, with
whom, and how many hours/days/weeks did you work?
4
5
CENTER FOR STUDENT LEADERSHIP
Student Information Sheet
Name:
Phone Number:
Email:
If possible, please provide 2 emails in the event that one should
not work.
T-Shirt Size:
Dress Shirt Size:
Jacket/Blazer Size:
Special Dietary Needs:
Allergies:
Emergency Contact Name
Emergency Contact Phone Number
Emergency Contact Relation to Student
Request for Letter of Recommendation
Due Date:
Personal Information
First Name Last Name
Street Address:
City: State: Zip Code:
Telephone Number:
This letter of recommendation is for
Center for Student Leadership membership application
To Whom Should This Letter Be Addressed?
Contact Name: Judy Elias Department: &HQWHUIRU6WXGHQW/HDGHUVKLS
Street Name or P.O. Box: 425706 City: Denton
State: Texas Zip Code: 76204
This Letter of Recommendation Should Emphasize (pick four areas):
Academic Record Research Experience
Scholarship Leadership Experience
Employment Campus Activities
Community Service Personal Character
Other:
Academic Record
Total Number of Hours Completed:
Cumulative GPA: Major GPA:
Major: Minor:
Graduation Date:
Professional Goals
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Center-for-Student-Leadership-Membership-Application Leadership Institute Membership Application

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Completed 18 November 2019

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