Business Institute Application

INSTRUCTIONS: Complete the application form. Make sure you fully answer all required questions. LEAD will only review applicants who submit the completed application form, short responses, news article, business essay, two recommendation forms, transcript form, an official high school transcript, copy of your standardized test scores and the $50 application fee. It is your responsibility to ensure that LEAD receives all materials by February 5, 2014.
Please list three LEAD Summer Business Institute locations you would be interested in attending if selected to participate. In order of preference (1-3 in the spaces below indicate only three locations). Please note that LEAD will try to honor your preferences, however your placement into a particular school is not guaranteed. First Choice: Second Choice: Third Choice:

PERSONAL INFORMATION
Legal Name:
Last (Family) First M.I. Suffix (Jr., Sr., etc.)

GENDER:

MALE

FEMALE

DATE OF BIRTH
(mm/dd/yyyy)

DO YOU RECEIVE FREE OR REDUCED LUNCH?

YES

NO

FROM WHOM DID YOU RECEIVE THIS APPLICATION? LEAD Teacher/Counselor LEAD Alumni: Name:

Other:

Foreign Language Proficiency: Career Objective: Favorite Quote: Favorite Author:

Travel Experiences:

PERMANENT ADDRESS
Street Address Apt. #

City

State

Zip Code

Email

Home Phone Number

Mobile Number

ETHNICITY
PLEASE CHECK THE BOX THAT BEST DESCRIBES YOUR ETHNIC BACKGROUND. Black/African American Caucasian Native American* Asian American/Pacific Islander: PLEASE SPECIFY: Latino: PLEASE SPECIFY: Other: PLEASE SPECIFY: Bi-Racial: PLEASE SPECIFY: Your Tribal Registration Number:

*Native American applicants must provide a photocopy of their Tribal Enrollment Card.
If you cannot supply a copy, please enter the following information:

Name of Tribe:

CITIZENSHIP
Place of Birth
City/Town State/Province Country

US Citizen

Dual US Citizen (please specify other country of citizenship): Permanent Resident #

Page 1

US Permanent Resident: Country of Origin

*You must provide a copy of your Permanent Resident card (Green Card) for verification.

LEADership, Education and Development 500 Office Center Drive, Suite 400, Fort Washington, PA 19034 (215) 261-7001 www.leadprogram.org apply@leadprogram.org

Business Institute Application

EXTRACURRICULAR AND COMMUNITY ACTIVITIES
List the school and community activities that are most important to you, listing any offices held and leadership roles first. Please be sure to note any memberships in business-oriented organizations. (Attach additional sheets as necessary.)
ACTIVITY GRADE LEVEL HOURS PER WEEK POSITIONS HELD/HONORS WON

9 9 9 9 9 9

10 10 10 10 10 10

11 11 11 11 11 11

EMPLOYMENT INFORMATION
EMPLOYER JOB TITLE/POSITION HELD DATES OF EMPLOYMENT HOURS PER WEEK

FAMILY INFORMATION
YOUR PARENTS MARITAL STATUS: YOUR SIBLINGS: BROTHERS: Number Age(s) Married Separated Divorced Widowed SISTERS: Number Year: Age(s) Single

NAME OF ANY FAMILY MEMBER WHO PARTICIPATED IN THE LEAD PROGRAM: NAME(S) OF THE PARENT(S) OR LEGAL GUARDIAN(S) WITH WHOM YOU LIVE: PARENT/GUARDIAN/OTHER NAME (LAST, FIRST, MIDDLE INITIAL) RELATIONSHIP TO THE APPLICANT (YOU) HOME ADDRESS, CITY, STATE, ZIP HOME TELEPHONE NUMBER E-MAIL ADDRESS EMPLOYER OCCUPATION/TITLE BUSINESS OR MOBILE TELEPHONE NUMBER HIGHEST GRADE COMPLETED COLLEGE ATTENDED (IF ANY) DEGREE/CERTIFICATE EARNED (IF ANY)

PARENT/GUARDIAN/OTHER

LEADership, Education and Development 500 Office Center Drive, Suite 400, Fort Washington, PA 19034 (215) 261-7001 www.leadprogram.org apply@leadprogram.org

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Business Institute Application

ACADEMIC INFORMATION
High School Name: High School Address: City: CURRENT GRADE LEVEL: Name of Counselor/Advisor: Counselor/Advisor Email Address: 11 State: Zip Code:

ADDITIONAL COMMENTS
Is there anything else you would like us to consider when reviewing your application?

Please review the form to make sure you have answered all questions. LEAD will only review applicants who submit the completed application form, short responses, news article, business essay, two recommendation forms, transcript form, an official high school transcript, copy of your standardized test scores and the $50 application fee. IT IS YOUR RESPONSIBILITY TO ENSURE THAT WE RECEIVE ALL REQUESTED MATERIALS BY THE DEADLINE. I certify that the information I have provided in this application (including required essays) is accurate and complete. I understand that it is my responsibility to submit a completed application by the application deadline.

Applicants Signature APPLICATION DEADLINE: FEBRUARY 5, 2014

Date

Email your completed application form, short responses, news article and business essay to apply@leadprogram.org. Be sure to include your name in the subject line of your email.
LEADership, Education and Development 500 Office Center Drive, Suite 400, Fort Washington, PA 19034 (215) 261-7001 www.leadprogram.org apply@leadprogram.org Page 3

Business Institute Application

SHORT RESPONSES
Essays help us learn more about you as a person. Please type your responses to the questions in the spaces provided. Each response may be up to 250 words.

Leadership as a term has evolved over the years. Give us your definition of what a 21st century leader looks like and how are you developing yourself to become one?

What are you most afraid of and how would you change the world?

Tell us how life skills (i.e. critical thinking, problem solving, etc.) help you become successful in careers like business?

LEADership, Education and Development 500 Office Center Drive, Suite 400, Fort Washington, PA 19034 (215) 261-7001 www.leadprogram.org apply@leadprogram.org

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Business Institute Application

BUSINESS ARTICLE
Step 1: Choose a news article about an important global business issue from the New York Times, Wall Street Journal or cnbc.com for your business essay. Paste a copy of the news article. The review panel will read your article to see that you have shared original ideas in your essay.

LEADership, Education and Development 500 Office Center Drive, Suite 400, Fort Washington, PA 19034 (215) 261-7001 www.leadprogram.org apply@leadprogram.org

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Business Institute Application

BUSINESS ESSAY
Step 2: Write an analysis (up to 500 words) about the global business issue highlighted in the article you selected. Why do you consider the issue important? What do you suggest should be done to address the issue? Your essay should not simply restate the article, but should focus on your opinion of how to change the issue.

LEADership, Education and Development 500 Office Center Drive, Suite 400, Fort Washington, PA 19034 (215) 261-7001 www.leadprogram.org apply@leadprogram.org

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! ! ! !

Business Institute Application Checklist

The LEAD Business application contains several elements all of which will contribute to your overall evaluation by the selection committee. In order to be considered for acceptance, all forms must be completed and all required documents included. Please remember, your application is our first impression of you so take your time working on it. Heres what you need: APPLICATION FORM
Complete the application form. Make sure you fully answer all required questions.

APPLICATION FEE
A $50 non-refundable application fee must accompany your application materials. Make the check or money order payable to LEAD Program and mail it to: LEADership, Education and Development, 500 Office Center Drive, Suite 400, Fort Washington, PA 19034. DO NOT SEND CASH. Applications received without the application fee will not be processed.

SHORT RESPONSES
Essays help us learn more about you as a person. Please type your responses to the questions in the spaces provided. Each response may be up to 250 words. 1. Leadership as a term has evolved over the years. Give us your definition of what a 21st century leader looks like and how are you developing yourself to become one? 2. What are you most afraid of and how would you change the world? 3. Tell us how life skills (i.e. critical thinking, problem solving, etc.) help you become successful in careers like business?

APPLICATION FEE WAIVER

If you require an application fee waiver, send a request to apply@leadprogram.org.

SUBMITTING YOUR APPLICATION

Email your completed application form, short responses, news article and business essay to apply@leadprogram.org. Be sure to include your name in the subject line of your email.

APPLICATION ASSISTANCE
If you need assistance with the application, please contact LEAD at (215) 261-7001 or apply@leadprogram.org.

NEWS ARTICLE
Step 1: Choose a news article about an important global business issue from the New York Times, Wall Street Journal or cnbc.com for your business essay. Paste a copy of the news article. The review panel will read your article to see that you have shared original ideas in your essay.

COST
Tuition for the LEAD SBI program is $1,150 for two-weeks; $1,750 for three-weeks; $2,450 for four-week programs. Additional program activity fees of $350 are required for SBI activities. Roundtrip airfare is not included in the tuition cost, students are responsible for their own travel.

BUSINESS ESSAY

S tep 2: Write an analysis (up to 500 words) about the global

business issue highlighted in the article you selected. Why do you consider the issue important? What do you suggest should be done to address the issue? Your essay should not simply restate the article, but should focus on your opinion of how to change the issue.

TUITION/TRAVEL SCHOLARSHIPS

RECOMMENDATION FORMS

Partial or full tuition and travel scholarships are available for students who require financial assistance. Admitted students should request and submit a scholarship application and financial documentation upon acceptance into the program.

LEAD requires each applicant to submit one academic and one personal recommendation form. The academic recommendation form should be completed by a teacher or advisor who can assess your work. The personal recommendation form should be completed by an employer, coach, community official, or minister who can comment on your personal attributes and involvement in the community. Both forms should be emailed to recommendations@leadprogram.org.

NOTIFICATION

All applicants will be notified in late March 2014. Notification for the program and all future correspondence will be conducted through email. Please be sure to provide a valid email address. Notification will not be made by telephone. The decisions of the selection committee are final. Application Deadline: February 5, 2014.

TRANSCRIPT FORM
Have a school counselor or administrator complete and sign this form.

PROGRAM LOCATIONS
The 2014 Summer Business Institute locations include: Dartmouth College Duke University Northwestern University University of Illinois at Urbana-Champaign University of Maryland, College Park University of Michigan, Ann Arbor University of Pennsylvania

HIGH SCHOOL TRANSCRIPT

An official high school transcript and school profile must accompany each applicants application to LEAD. The transcript should include your current first semester grades. If not, please submit your current semester grades or a copy of your report card. Please ask a school administrator to forward your transcript, school profile and a copy of your current semester grades or report card to: LEADership, Education and Development, 500 Office Center Drive, Suite 400, Fort Washington, PA 19034.

STANDARDIZED TEST SCORES

Please submit a copy of your PSAT, SAT or ACT score reports you receive in the mail or printouts from the testing organization website with your scores on it. SAT II subject scores and AP test results are not reviewed. Please do not send us your official score reports directly from the testing organization. Please email a copy of your scores to apply@leadprogram.org.

International: Canada: (London, Ontario) Ivey Business School at Western University

LEADership, Education and Development ! 500 Office Center Drive, Suite 400, Fort Washington, PA 19034 ! (215) 261-7001 ! www.leadprogram.org ! apply@leadprogram.org

500 Office Center Drive, Suite 400 Fort Washington, PA 19034 Phone: (215) 261 -7001 www.leadprogram.org recommendations@leadprogram.org

TRANSCRIPT FORM
Check all that apply: BUSINESS INSTITUTE ENGINEERING INSTITUTE COMPUTER SCIENCE INSTITUTE (Level II) Please fill in your contact information below. This form should be completed by a counselor/advisor. t Name: Address: Phone: Email:

AUTHORIZATION FOR INFORMATION RELEASE: Please sign this form and forward it to your guidance counselor/advisor for completion. I hereby authorize my school to release the information requested below. Applicants Signature: SCHOOL INFORMATION This section must be completed by a guidance counselor/advisor. Type of School: (check one) Public Private Parochial Home Schooled Other: Name of School: Current Grade Level: STANDARDIZED TEST SCORES PSAT Critical Reading: PSAT Math: PSAT Writing: SAT Critical Reading: SAT Math: SAT Writing: PLAN: ACT: Class Rank: Class Size: GPA: Scale: Date:

CERTIFICATION: I hereby certify that the information I have provided is accurate and true as of the date indicated below. Name of Counselor/Advisor: Signature of Counselor: Email: Date:

MAILING INSTRUCTIONS: Once completed, please send this form along an official high school transcript, current semester grades or report card and a school profile to:

LEADership, Education and Development 500 Office Center Drive, Suite 400 Fort Washington, PA 19034 DEADLINE: FEBRUARY 5, 201
LEADership, Education and Development 500 Office Center Drive, Suite 400, Fort Washington, PA 19118 Phone: 215.261.7001Website: www.leadprogram.org E -mail: recommendations@leadprogram.org

500 Office Center Drive, Suite 400 Fort Washington, PA 19034 Phone: (215) 261-7001 www.leadprogram.org recommendations@leadprogram.org

ACADEMIC RECOMMENDATION FORM

Check all that apply: BUSINESS INSTITUTE ENGINEERING INSTITUTE COMPUTER SCIENCE INSTITUTE (Level II)
Please fill in your contact information below. This form should be completed by a counselor, teacher or club advisor who can assess your work.

Applicant Name: Address:

Email: Phone:

The above applicant is applying for admission to the LEAD Program and has given your name as a reference. The information you are providing concerning the above named applicant is considered an important part of the application process. Specific statements and your candid assessment of the applicants potential will be very helpful. We appreciate the information you are pro viding and for sharing your observations about the applicant.
Instructions: After completing this form, email it to recommendations@leadprogram.org. This form must be received by February 5, 2014.

(Check one) COUNSELOR MATHEMATICS TEACHER SCIENCE TEACHER OTHER:

1. In what ways would you distinguish this applicants academic performance from other applicants?

2.

In what areas does the applicant need improvement?

3.

How well do you feel the applicant handles disappointment or differences of opinion?

4.

Do you think that this applicants grades are a valid reflection of his/her academic abilities? Please explain.

LEADership, Education and Development 500 Office Center Drive, Suite 400, Fort Washington, PA 19118 Phone: 215.261.7001Website: www.leadprogram.org E -mail: recommendations@leadprogram.org

500 Office Center Drive, Suite 400 Fort Washington, PA 19034 Phone: (215) 261-7001 www.leadprogram.org recommendations@leadprogram.org

ACADEMIC RECOMMENDATION FORM (CONTINUED)

Applicant Name: In terms of characteristics listed below, please give us your appraisal of the applicant:
CATEGORY INQUISITIVE: Looks beyond what is apparent, questioning attitude/needs to know why. PERSISTENT: Stays with tasks, integration toward long-term goals. SELF-STARTER: Highly motivated, independent worker, self-directed, pursues individual interests. DESIRE TO ACHIEVE: Is eager to successfully accomplish goals. DISCIPLINED WORK HABITS: Turns in assignments in a timely manner. SENSE OF COMMUNITY: Takes responsibility for actions, shows respect for teachers and peers. LEADERSHIP: Shows maturity/emotional ability, leads when needed or appropriate. COMMUNICATION SKILLS: Ability to express thoughts clearly, creatively and concisely. ETHICAL: Honest and forthright, knowing right from wrong. Outstanding Good Average Below Average Unable to Assess

I have known the applicant for OVERALL RATING: Strongly recommend Recommend

year/s and/or

month/s

Recommend with reservations (explain any reservations below)

COMMENTS: Please use this space to provide any additional information that the committee should consider when evaluating this applicant, including your involvement with him/her outside the traditional classroom, his/her ability to meet personal responsibilities, deadlines, personal initiative, etc. Please also include any obstacles this applicant has had to overcome in pursuing his or her educational goals, if appropriate.

Signature: Name: Institution:

Date: Email Address: Title:

Telephone:

LEADership, Education and Development 500 Office Center Drive, Suite 400, Fort Washington, PA 19118 Phone: 215.261.7001Website: www.leadprogram.org E -mail: recommendations@leadprogram.org

500 Office Center Drive, Suite 400 Fort Washington, PA 19034 Phone: (215) 261-7001 www.leadprogram.org recommendations@leadprogram.org

PERSONAL RECOMMENDATION FORM

Please fill in your contact information below. This form should be prepared by an employer, coach, community official or minister.

Applicant Name: Address:

Email: Phone:

The above applicant is applying for admission to the LEAD Summer Business Institute Program and has given your name as a reference. The information you are providing concerning the above named applicant is considered an important part of the application process. Specific statements and your candid assessment of the applicants potential will be very helpful. We appreciate the informati on you are providing by completing this form and for sharing your observations about the applicant.
Instructions: After completing this form, email it to recommendations@leadprogram.org. This form must be received by February 5, 2014.

1.

How long have you known the applicant and in what capacity?

2.

What are the first words that come to mind to describe the applicant?

3.

In what ways does this applicant show evidence of leadership ability?

4.

How does this applicant demonstrate commitment?

5.

What are the applicants strengths and weaknesses?

LEADership, Education and Development 500 Office Center Drive, Suite 400, Fort Washington, PA 19118 Phone: 215.261.7001Website: www.leadprogram.org E -mail: recommendations@leadprogram.org

500 Office Center Drive, Suite 400 Fort Washington, PA 19034 Phone: (215) 261-7001 www.leadprogram.org recommendations@leadprogram.org

PERSONAL RECOMMENDATION FORM (CONTINUED)

Applicant Name: In terms of characteristics listed below, please give us your appraisal of the applicant:
CATEGORY INQUISITIVE: Looks beyond what is apparent, questioning attitude/needs to know why. PERSISTENT: Stays with tasks, integration toward long-term goals. SELF-STARTER: Highly motivated, independent worker, self-directed, pursues individual interests. DESIRE TO ACHIEVE: Is eager to successfully accomplish goals. DISCIPLINED WORK HABITS: Turns in assignments in a timely manner. SENSE OF COMMUNITY: Takes responsibility for actions, shows respect for teachers and peers. LEADERSHIP: Shows maturity/emotional ability, leads when needed or appropriate. COMMUNICATION SKILLS: Ability to express thoughts clearly, creatively and concisely. ETHICAL: Honest and forthright, knowing right from wrong. Outstanding Good Average Below Average Unable to Assess

OVERALL RATING: Strongly recommend

Recommend

Recommend with reservations (explain any reservations below)

COMMENTS: Please use this space to provide any additional information that the committee should consider when evaluating this applicant, including your involvement with him/her outside the traditional classroom, his/her ability to meet personal responsibilities, deadlines, personal initiative, etc. Please also include any obstacles this applicant has had to overcome in pursuing his or her educational goals, if appropriate.

Signature: Name: Institution:

Date: Email Address: Title:

Telephone:

LEADership, Education and Development 500 Office Center Drive, Suite 400, Fort Washington, PA 19118 Phone: 215.261.7001Website: www.leadprogram.org E -mail: recommendations@leadprogram.org