2017 Summer Leadership Institute Application 1. Your information Question Title * Please provide your personal information. First Name Last Name Mailing address City, ST, ZIP Email address Phone Number Name of high school/college/university currently attending Year in school Expected graduation date Major/Minor field of study GPA Question Title * Faculty/staff member who has agreed to assist applicant in obtaining funding for participation in the program: Faculty name Faculty email Faculty phone number Question Title * Please list any dietary restrictions: Question Title * How did you hear about the Summer Leadership Institute? Faculty/staff recommendation Program materials (poster, brochure, email) Social media Mount Mary University Women's Leadership Institute College/university referral Other (please specify) Question Title * Mount Mary University Women’s Leadership Institute is committed to serving students of all races, ethnicities, national origins, religions, sexual orientations, and political party affiliations.Students from all areas of study are encouraged to apply. The information requested below will help us to measure our effectiveness at connecting with underrepresented populations during recruitment and programming, but it is not required. Native American/American Indian African‐American/Black Asian/Asian‐American Latina/Chicana Anglo‐, Euro‐American/White Middle Eastern/North African Other (please specify) Page1 / 3 33% of survey complete. Next