Apply - Leaders 4 Social Change

We will take applications on a rolling basis beginning April 1st.

Application Form

If you are human, leave this field blank.

Parent Name *

Parent Email *

Parent Phone *

Child Name *

Address *

Address

Street Address 1

Street Address 2

City

State/Province

Zip/Postal

Country

Child Date of Birth *

Child Grade in 2019-2020 *

Name of Current School *

Weeks Interested In: *

Week 1: Writing Focus ($150)

Week 2: Speaking Focus ($150)

Both Weeks ($250)