2019 GLLI Deadline: Friday, June 7th, 2019 Please fill out the application below to attend the Goddard Leadership Legacy Institute, held at the Ironmaster's Mansion at Pine Grove Furnace State Park, PA. Once submitted, applications will be reviewed by the Central Pennsylvania Conservancy and acceptance notices will be sent via email. The decision is based primarily on the age requirement-students must be 13 by July and not older than 15, and demonstrate an interest and experience in the program activities. No more than 15 students will be accepted into the program. Thank you for your interest in the Goddard Leadership Legacy Institute. Personal InformationStudent Name* First Last Parent Contact Name* First Last Student Gender*MaleFemaleCurrent Grade*Student Age*Student Date of Birth*ex. 11/05/2000School*School District*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Primary Phone*Secondary PhonePrimary Email Contact* Enter Email Confirm Email Secondary Email Contact Enter Email Confirm Email T-Shirt Size (adult sizes)*SmallMediumLargeXLShort ResponsesWhat previous outdoor or environmental education experiences have you had? (This may include experiences such as camping, hiking, using a compass, or hiking.)*List school clubs, programs, or community organizations in which you are currently active, along with any leadership position you have held or leadership roles you have played.*ReferencesPlease provide information for two references from teachers, community group leaders, coaches, or adult family members who can attest to your interest in and eligibility for this program.Reference 1 Name* First Last Email* Phone*Reference 2 Name* First Last Email* PhoneShort EssayIn 150 words or less, please describe why you would like to attend the Goddard Leadership Legacy Institute and how you learned about the opportunity.*What makes you a good candidate for a scholarship to attend the Goddard Leadership Legacy Institute?*Any concerns or questions you would like to share about the Goddard Leadership Legacy Institute program?*Thank you for your interest, and we look forward to reviewing your application! The Program Director will respond shortly to your application with notification of acceptance. Payment of $350 for the Goddard Leadership Legacy Institute is due in mid-June, when invoices are mailed out. At that time, you will be notified whether your student has received a partial scholarship and the invoice will be adjusted accordingly.* Price: $350.00
