Leadership Application - Southwestern College

Leadership Application

Full Name*

First NameLast Name

Phone*

Area CodePhone Number

If you have also applied to other Service Learning Teams here at SC, please check them:

Discipleship SouthwesternGreen Team Southwestern

Briefly describe yourself and your background: *

How do you expect to benefit from this program? *

Choose a local, national, or international problem that is of interest to you. Explain why the issue is important to you and how you would address the situation if you were involved in it in a leadership position: *

Please list any extracurricular and/or community activities in which you are involved: *

Please include volunteer work:

As part of your application process, you will need to provide two references. List each reference below. Once you submit this form, you will be given a link to an online Reference Form to share with each reference for them to fill out. Please list employers, teachers/professors, pastors or any other organization leaders for your references. Note: References cannot be family members.

Reference Information:*

Waiver of Access: I have requested that this recommendation be filed for use in the selection process for the Leadership Southwestern team. In accordance with the Family Rights and Privacy Act of 1974, I have indicated my intention regarding access to this recommendation by checking one of the following options: *

I waive access to this recommendation which shall therefore be considered confidential.I do not waive access to this recommendation.

By typing my name in the Signature textbox below and submitting this online form I certify under penalty of perjury that all information provided is correct and complete. I understand that my application is not valid if I have knowingly falsified information.

Signature*

Southwestern College is committed to a policy of nondiscrimination on the basis of race, color, gender, age, religion, national origin, handicap, or other nonmerit reasons, in admissions, educational programs or activities, and employment, all as required by applicable laws and regulations. Responsibility for coordination of compliance efforts and receipt of inquiries, including those concerning Title IX of the Education Amendments of 1972 and Section 504 of the Rehabilitation Act of 1973, has been delegated to the vice president for business affairs, Christy Administration Building, Southwestern College, 100 College Street, Winfield, KS 67156-2499, (620) 229-6000. Southwestern College complies with the Crime Awareness and Campus Security Act of 1990. The yearly report is available from the dean of students upon request. Race and ethnic origin information is voluntary and will not be used in a discriminatory manner.

Biographical Information

Personal Statement

References

Signature