Prize for Leadership Program Application

First Name

Last Name

Preferred Name

Personal Email Address (please use a non-school email you'll keep long-term, like Gmail or Yahoo)

Mailing Address

Country

Street

City

Region

Postal Code

Home Phone

Mobile Phone

Birthdate

Student Gender Assigned at birth

Social Security Number

*Please note, eligible winners will need to provide the SSN in order to receive the cash prize award for tax purposes.

Current High School

HS Graduation Year

I am interested in

Primary Citizenship:

Are you a permanent resident of the United States?

What is your visa status?

Parent/ Guardian 1

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email

Parent/Guardian Phone Number

Relation to Student

Parent/ Guardian 2

Parent/Guardian First Name 2

Parent/Guardian Last Name 2

Parent/Guardian Email 2

Parent/Guardian Phone Number 2

Relation to Student

Student's Guidance Counselor

Guidance Counselor First Name

Guidance Counselor Last Name

Guidance Counselor Email Address

Personal Statement/ Essay

On a separate document, please type a brief response (250-500 words) to the following questions:

How have you impacted your school or broader community by being a leader?

How do you plan to integrate your leadership skills with your future academic studies and career plans?

Upload your statement

Upload File

Extracurricular and Volunteer Activities

Please upload a resume or list of your extracurricular and volunteer activities, including the name of each activity, organization, dates involved, leadership roles held, and key accomplishments.

Upload File

Letter of Recommendation and Transcripts

If your recommender would like to submit the recommendation directly, please have them submit the online form which will be shared with you once you submit your application.

Please provide the following:

1-2 letters of recommendation from a high school administrator, school counselor, high school teacher or a supervisor of volunteer activities. Please note: your teachers/guidance counselors can choose to submit their letters separately.
A high school transcript

Will your letters of recommendation be sent directly from the recommender?

Letter of Recommendation or Letter from Supervisor

You've selected that your recommender(s) will send us their letters of reference separately. Please have them email the letter to apply@adelphi.edu with your first and last name.

Transcript

Certification

Agreement

I certify that all statements made in this application are true, complete, and correct to the best of my knowledge and believe, and are made in good faith.