Apply – Leaders 4 Social Change

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

Application Form

If you are human, leave this field blank.

Parent Name *

Parent Email *

Parent Phone *

Child Name *

Child Email *

Please create an email for you child if they do not have one. We'll need these to set up our Google Classroom. Do not use a school email, as they do not work with Google Classroom.

Child Phone Number

Address *

Address

Street Address 1

Street Address 2

City

State/Province

Zip/Postal

Country

Child Date of Birth *

Child Grade in 2020-2021 *

Name of Current School *

Location *

Weeks Interested In: *

Week 1: Writing Focus ($250)

Week 2: Speaking Focus ($250)

Both Weeks ($300)