Leadership Camp Application

First Name*

Last Name*

Address*

Street Address Address Line 2 City State ZIP Code

School District*

School Name*

Michigan County*

Email*

Phone*

Name of Parent or Guardian*

Parent Email*

What grade are you entering in the fall?*

Have you previously received a SET SEG Leadership Camp scholarship?*

What year(s)?

How many years have you attended the Leadership Camp?*

List any school-related extra-curricular activities you participate in:*

List any community activities you participate in:*

In 150 words or less, who has been a leader in your life and how have they inspired you?*

In 150 words or less, describe a time you recognized a need for self-growth.*

In 150 words or less, describe your unique circumstances and how receiving this scholarship will impact you.*