LFPAppSec01 - Higher Education & Leadership Ministries

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I confirm that I'm applying for the 2023-2024 Leadership Fellows Program *

Leadership Fellows Program 2023

I confirm that I am a member of Christian Church (Disciples of Christ) congregation *

Member of Disciples Congregation

I confirm that I will be attending college for the first time in 2023-2024 *

First year college student

Will you participate in a non academic fall activity that will make attendance at the mandatory annual retreats difficult? If yes, what are the activities? *

First Name *

Last Name *

Preferred Name

Date of Birth *

Gender *

Briefly describe your racial, ethnic or cultural background

Email *

Please, make sure to use the same email for all four sections.

Cell Phone *

Mailing Address *

Apt, Suite, etc. If necessary

City/Town *

State/Province *

Country *

Zip Code *

If other country, please specify:

Parent & Family Information

Parent or Guardian's Information

The following information is in regards to the applicant's parent or guardian.

A. Full Name *

A. Relationship to You *

A. Email Address

A. Phone Number

Additional Parent or Guardian's Information, if appropriate

B. Full Name

B. Relationship to You

B. Email Address

B. Phone Number

Parent or Guardian's Mailing Address *

Please, enter a mailing address for the parent(s) or guardian(s) named above. If the address is the same as your mailing address stated above, enter "same as above." If more than one parent or guardian are named and both have different addresses, please enter both.

Church Information

Your Home Church *

Home Church's Location *

Phone Number *

Pastor's Full Name *

Include title and/or position if applicable

School Information

High School Information

High School Transcript

Request an official transcript from your school. Unofficial transcripts, grade reports, or transcript submitted directly by the applicant will not be accepted. Your school can submit your transcript on your behalf through one of the following two methods: Via email By April 30, 2023 11:59 PM EST Rev. Katy Sundararajan Higher Education & Leadership Ministries ksundararajan@helmdisciples.org OR Via mail Postmarked by April 30, 2023 Rev. Katy Sundararajan Higher Education & Leadership Ministries PO Box 1986 Indianapolis, IN 46204

Checkbox *

I requested my school to furnish officials transcripts to HELM

Transcript delivery method *

High School and Location *

Please, include name of school, town/city & state/province

Rank and Class Size *

Include your rank and the class size. If your school does not rank, enter "0"

GPA *

Enter your current GPA and scale. If your school does not provide GPA, enter "0"

Expected Graduation *

College Information

Which describes you best? *

To which colleges have you applied? *

What school are you most likely to attend? *

What concentration or major is of interest to you? *

Submit

How did you hear about the Leadership Fellows Program? *

I affirm that all answers have been provided by myself (the applicant) and are correct to the extent of my knowledge.

Signature *

Please enter your name as your signature

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Leadership Fellows Program 2023 Application Section I

Parent & Family Information

Parent or Guardian's Information

Church Information

Church Information

School Information

High School Information

College Information

College Information

Submit