Germantown Municipal School District
2023-2024 Leadership Academy
Student Information
LAST NAME
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FIRST NAME
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STREET ADDRESS
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CITY
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STATE
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ZIP CODE
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E-MAIL ADDRESS
DATE OF BIRTH
*
-
Month
-
Day
Year
Date
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Parent Information
PARENT #1 NAME
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PARENT #1 PHONE
*
PARENT #1 EMAIL
*
PARENT #2 NAME
PARENT #2 PHONE
PARENT #2 EMAIL
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Education
STUDENT'S PREVIOUS SCHOOL:
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STUDENT'S CURRENT GRADE:
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PLEASE ATTACH A COPY OF THE STUDENT"S MOST RECENT REPORT CARD
*
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Extracurricular
HAVE YOU APPLIED FOR THE HONORS ACADEMY AT HOUSTON HIGH SCHOOL?
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YES
NO
DID YOU HAVE LEADERSHIP ROLES AT YOUR PREVIOUS SCHOOL? (I.E. STUDENT COUNCIL, STUDENT GOVERNMENT)
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YES
NO
IF PREVIOUS ANSWER WAS YES, PLEASE EXPLAIN.
EXTRACURRICULAR ACTIVITY:
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GRADE PARTICIPATED
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6th
7th
8th
9th
BRIEF DESCRIPTION OF YOUR ROLE:
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EXTRACURRICULAR ACTIVITY:
GRADE PARTICIPATED
6th
7th
8th
9th
BRIEF DESCRIPTION OF YOUR ROLE
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Writing Sample
CHOOSE ONE OF THE FOLLOWING PROMPTS AND ATTACH A RESPONSE IN A MAXIMUM OF THREE PARAGRAPHS. APPLICATIONS SUBMITTED WITHOUT A WRITING SAMPLE WILL NOT BE PROCESSED.
What is your definition and expectation of leadership?
Choice 1
Describe a time when you were involved with a failure in leadership. What did you learn from the situation?
true
What are some behaviors and actions you have encountered from your experience with great leaders?
Choice 3
ATTACH WRITING SAMPLE
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Submit
Should be Empty: