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* 1. Name

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* 3. Phone

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* 4. Address

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* 5. Date of Birth

Date

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* 6. Student Information

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* 7. Parent's name

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* 9. Parent's phone

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* 10. Parent's address

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* 11. Emergency Contact

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* 12. T-Shirt Size

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* 13. Why do you want to participate in the Summer Leadership Academy?

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* 14. What does leadership mean to you?

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* 15. What issue would you like to solve in your community?

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* 16. Do you give consent to have your image in promotional materials

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* 17. Do you agree to attend all sessions?

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* 18. Parent Guardian E-Signature

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