DRAFT: This module has unpublished changes.



2012 LEAD Academy Application

Leadership in Education, Action and Development

Center for Service and Citizenship

Massachusetts College of Liberal Arts

August 4th – August 8th, 2012


This application must arrive by end of the business day of Friday, July 23rd, 2012. Applications will be reviewed and spots filled on a rolling basis. Since enrollment is limited, your chances increase greatly if you apply immediately.  This application can be emailed to spencer.moser@mcla.edu, faxed to 413-662-5170 or mailed to MCLA- LEAD Academy, Student Affairs, Spencer Moser, 375 Church Street, North Adams, MA 01247. The $200.00 program fee must be included with this application. The program fee covers costs of all room and board, transportation during the program, activities fees and all other scheduled events. Checks should be made out to Massachusetts College of Liberal Arts. Please call 413-662-5251 or email spencer.moser@mcla.edu  with any questions.


Personal Information


Full Name: _____________________________________________     


Intended Major:__________________________________________     

Home Mailing Address: ______________________________________

City, State, Zip: _____________________________________________

Date of Birth: _____________ Home Phone: ____________________


Cell Phone: ________________________ Primary Email: ___________________

Emergency Contact:                           ____________________________________________                                     

Address: ____________________________________Phone: ____________________________

Please check here if program fee of $200.00 is attached to this application: ______

Checks should be payable to Massachusetts College of Liberal Arts. Fee refunds will be made through Friday, July 27th,     2012.  After that date, no refunds will be made.



-Turn Over, Application Questions on Back-

  Please type responses to the following questions on a separate piece of paper.


1.  Why do you want to participate in LEAD Academy, and what do you hope to gain from the program?



2.  What personal, professional and academic skills, perspectives and/or competencies are you interested in developing at LEAD?



3.  If you have done community service/volunteer work before, please describe what you did, your role, and its impact on you and the community, if any. If you have not previously participated in community service and volunteer work, why are you interested in it now, and what attracts you to it?



4.  What unique qualities do you bring to the LEAD Academy that would enhance the program? Have you ever participated in a similar program?  If so, please explain.



5.  How do you feel participating in community service and student engagement programs would help contribute to or support your college education?



6. What activities are you hoping to participate in while at MCLA?  What leadership positions are you interested in fulfilling while at MCLA? What clubs and organizations are you interested in becoming a member of?



7. How would you describe yourself as a person? Consider yourself as a friend, leader, student, and community member.


8. Anything else you would like to add?



This application must arrive by end of the business day of Friday, July 23rd, 2012.

Be sure to include the $200.00 program fee.


DRAFT: This module has unpublished changes.