Thank you for your interest in attending the 2017 USBLN Annual Conference! You must complete all the information on this application form and then email your current resume to Keri Gray at by Wednesday, May 10th.

The USBLN especially encourages STEM majors, veterans, students of color, and LGBTQ+ students with disabilities to apply.
If you are selected to attend the 2017 Rising Leadership Academy & USBLN Annual Conference, you will be required to:
1) Provide any required information, complete pre-conference assignments and post-conference report by required due dates.
2) Participate in ALL conference preparation calls. There will be 2-4 calls in the month of July, and they will be in the evenings from 8:00pm ET - 9:30pm ET.
3) The dates for the Academy and Conference are August 19 - 24, 2017 in Orlando, FL. You must be able to attend ALL the Rising Leadership Academy and participate in the USBLN Annual Conference sessions by taking full advantage of the education and networking opportunities. 
4) Conduct yourself in a professional manner at all times during the events.
5) Failure to meet the expectations outlined above may result in the cancellation of conference attendance and funding. 
If you have any questions, contact Keri Gray at

* 1. Are you a person with a disability?

* 2. Contact Information

* 3. What is your GPA?

* 4. Are you employed?

* 5. Describe your career aspirations and dream job. (Response must be a minimum of 100 words and a maximum of 400 words.)

* 6. Describe why you are interested in the Rising Leadership Academy.

* 7. Do you participate in any extracurricular activities or volunteer work?

* 8. As part of the Rising Leadership Academy, you will be assigned to a project team for the Technology Innovation Lab Activity. Please select from the following list, all the skills/expertise that you possess. We will use this information to form project teams.

* 9. How did you hear about the 2017 Rising Leadership Academy & USBLN Annual Conference? Select all that apply.

* 10. Do you have any dietary requirements? Select all that apply.

* 11. Do you have any meeting accommodation requests, accessibility needs and/or any mobility equipment used we should be aware of in order to make your experience more comfortable?

* 12. Do you need a hotel room in Orlando, FL? *If yes, you may receive a roommate with a fellow Rising Leadership Academy participant.

* 13. Gender Identity?

* 14. What is your age?

* 15. Do you identify as LGBTQ+?

* 16. Race/Ethnicity?

* 17. Are you a Veteran?

* 18. Are you studying or working in the STEM field?

* 19. Are you participating in the 2017 Rising Leaders Mentoring Program?

* 20. Are you an alum of any of the USBLN Rising Leaders Programs?

* 21. Are you a part of the WRP program?

* 22. Do you have a VR Counselor?