2018 National Baptist Convention of America LEAP Program Registration Form

June 26 - June 29 ~ Dallas, Texas

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* 1. What is your first and last name?

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* 2. Your Contact Information

Address

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Cell Number

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* 3. Name of Church & Pastor

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* 4. Name of High School, College or University

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* 5. Please Check All That Apply

I have a Grade Point Average of 3.0 or Above.

I am actively involved in leadership activities with my church, school and community.

I can commit to 40-hours of leadership activities in my church, school and community throughout the 2018-2019 LEAP Program Year

I plan to attend the National Baptist Congress & Youth Convention June 26 - June 29 in Dallas, Texas.

I can complete the minimum requirement of 5-interactive online leadership training courses through Christian University Global Net between January, 2019 - May, 2019.

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* 6. Have you done the following?

Forwarded your photo to LEAP Program Administration? *Must be received by June 15, 2018. Click Here: leapteam@nbcainc.com

Forwarded your bio to LEAP Program Administration? *Must be received by June 15, 2018. Click Here: leapteam@nbcainc.com

Forwarded your letter of recommendation from your Pastor to LEAP Program Administration? *Must be received by June 15, 2018. Click Here: leapteam@nbcainc.com

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* 1. What is your first and last name?

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* 2. Your Contact Information

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* 3. Name of Church & Pastor

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* 4. Name of High School, College or University

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* 5. Please Check All That Apply

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* 6. Have you done the following?

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* 7. List your current leadership activities