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PART I - INDIVIDUAL COLLEGE DEVELOPMENT PLAN (ICDP)

LEADERSHIP ACADEMY APPLICATION 2023

First Name

Last Name

Previously Enrolled in Project Ready?

Yes

If yes, please indicate the date participant was enrolled

Date of Birth

Age

Student Cell Number

Student Email

Grade level 2023 - 2024 school year

Freshman

Sophmore

Junior

Senior

GPA

ACT Score

School attending now

Home Address

City

State

Zip Code

Ethnicity

American Indian

Asian American

Black or African American

Hispanic or Latino

Native Hawaiian or Pacific Islander

White or Caucasian

Other

Name of Parent/Guardian 1

Parent 1 Phone Number

Parent 1 Email

Name of Parent/Guardian 2

Parent 2 Phone Number

Parent 2 Email

Age of Sibling 1

Age of Sibling 2

Age of Sibling 3

Age of Sibling 4

Have siblings attended college?

Yes

What other Urban League programs previously enrolled or currently enrolled in?

List all extracurricular activities/hobbies.

List medical and/or food allergies

PART II - ACADEMIC PREPARATION

STUDENT SELF-ASSESSMENT FORM

Student must complete this form as a part of Youth Intake Process

Do you consider yourself to be an academically strong student?

Yes

Somewhat

Do you enjoy new academic challenges?

Yes

Somewhat

Do you enjoy studying by yourself?

Yes

Somewhat

Do you enjoy studying in a group?

Yes

Somewhat

Do you see yourself going to college?

Yes

Will you be the first in your family to attend college?

Yes

Have you visited a college campus before?

Yes

Do you consider yourself popular in your school?

Yes

Somewhat

Do you find it easy to make friends?

Yes

Somewhat

Do you have friends from a different race or ethnicity?

Yes

Somewhat

What will be your future profession?

List your three college choices

Shirt Size

Small

Medium

Large

Extra Large

2X Large

I agree to the terms & conditions

View terms of use

To ensure the safety of all participants and staff, we require that parents and/or legal guardians sign all applicable forms. Please make sure that you review and sign any forms related to the 2023 Leadership Academy.

Your Signature

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LEADERSHIP ACADEMY APPLICATION 2023

STUDENT SELF-ASSESSMENT FORM

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