Institute of Civic Engagement for Emerging Leaders
July 17-28, 2017
 
Please note that tuition is due with the application.  
Acceptance into the Institute is not guaranteed until tuition has been received.
Payment can be made online. 
After completing the form you will be directed to the online payment page.
 
Questions?  adrienne@thevolunteercenter.org 
 
 
Your Email:
 *
Student First Name:
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Student Last Name:
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Gender
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Click here if you are a Student Action Board (SAB) member or Junior Leadership Durham (JLD) student.
Parent/Guardian First Name:
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Parent/Guardian Last Name:
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Home Street Address:
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City:
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State:
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Zip:
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Student's email
 *
Parent's Email:
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Student's Phone:
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Parent's Phone:
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Grade in school, Fall 2017:
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School Name:
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School District of School Attending 2016-2017:
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Food Restrictions
 
Allergies (list all)
 
Medical Conditions:
 
Age as of July 18, 2017
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Are you able to bring a personal laptop or tablet to The Institute
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Latest GPA (Weighted):
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Describe yourself in one word.
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What do you hope to gain from being a part of this institute? (100-300 words):
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Define what civic engagement means to you? (100-300 words):
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How will attending this institute help you achieve your goals? (100-300 words):
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Describe a social issue in your community. What can you do to be a part of the solution? (100-300 words):
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How did you hear about The Institute:
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Verification Code:
Insert above code:
 * Required


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