REGISTRATION FORM

Thank you for your interest in the Leadership LIVE program.  We're excited that you have chosen to participate in this leadership development program for our students at Thomas Jefferson University!

Please enter your information below to sign-up for the 2019-20 Leadership LIVE Program.  Please note that you must complete all parts of the form in full in order for your registration to be complete.  Incomplete registrations will be deleted.

Questions?

Call the Office of Student Life and Engagement at 215-503-7743 or email us at StudentLife@jefferson.edu.

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* 1. STUDENT INFORMATION

Please Note: The way that you list your name below will be how it appears in any communication and documents pertaining to the Leadership LIVE program (e.g. Leadership Transcript and/or Leadership Certificate).


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* 2. Please enter the phonetic pronunciation of your first and last name. This will allow us to properly address you throughout the program.

For example if your name is Jonah Nachum you might list the phonetic pronunciation as "joe-nah knock-um" or if your name is Ariana LeFevre you might list the phonetic pronunciation as "air-ree-ahn-a la-FEEV-er" which shows where the emphasis goes.

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* 3. CONTACT INFORMATION

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* 4. CAMPUS

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