Student Application

Send us your information and we will email you instructions about joining a class in your location.

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Name *

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Last

Email *

Phone Number *

Date of Birth *

Address *

Current School Attending

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Name of Parent or Guardian *

Parent or Guardian's Email *

Parent or Guardian's Phone Number *

Parent or Guardian's Address *

List any allergies or health concerns

Write a brief paragraph of why you want to be in the Leadership Academy

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