2019 College Leaders Career Conference Application

1. Application

Please note that there is no way to save a partially completed application and return to work on it later. Please do not submit your application until it is complete.

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* 1. First name

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* 2. Middle name

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* 3. Last name

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* 4. Nickname or preferred name

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* 5. Email address (Please make sure this is an email account you check regularly as this is how we will contact you after you submit your application)

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* 6. Alternate email address

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* 7. College/University Name:

Your current mailing address:

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* 8. Street:

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* 9. City, State:

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* 10. Zip code:

Your permanent mailing address (if different from above):

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* 11. Street:

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* 12. City, State:

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* 13. Zip code:

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* 14. Primary phone number

Cell

Home (landline or permanent number)

Work

Other

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* 15. Cell phone number

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* 16. Home phone number (landline or permanent number, if applicable)

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* 17. Other phone number

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* 18. Based on the map below, which Sorensen Institute region do you go to school in (or choose "out of state")?

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* 19. College Major

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* 20. Secondary major/minor

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* 21. Year in school?

Freshman

Sophomore

Junior

Senior

I graduated in December 2018 or am graduating in May 2019

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* 22. High school name

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* 23. High school city

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* 24. Based on the map below, which Sorensen Institute region is your hometown in (or choose "out of state")?

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Please note that for the following questions there is a 300-word limit on each question. Please check the word count on your short answer questions carefully before submitting them.

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* 25. Tell us about an instance when you displayed leadership by making an important contribution in a political or public service context. What challenges did you face along the way? What was the end result?

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* 26. Tell us about a time you went into a situation with an opinion, and through engaging with someone who had a different opinion or perspective from you, you changed your mind or your opinion evolved? This can be a political example or a personal example.

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* 27. What policy issues in Virginia inspire you to get involved?

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* 28. What are your professional or academic goals for after you graduate?

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* 29. What specific skills, knowledge or resources do you hope to acquire as a result of participating in the Sorensen Institute College Leaders Career Conference?

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* 30. Is there anything else you would like us to know or take into consideration that has not been included on this application form?

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* 31. How did you learn about the Sorensen Institute?

The next page will take you to some questions that are used for conference planning purposes only. They will not be used in evaluation of your application. Please make sure your answers above are finalized before continuing on.