Southeastern Community College


Presidential Leadership Academy Application


First Name:

Middle Initial: enter 'X' if no middle initial

Last Name:

E-Mail Address:

Street:

City:

State:

Zip:

Phone:  Please include area code.

Birth Date:

High School:

High School Graduation Year:

Anticipated Graduation Date from SCC:

Number of Credits Completed:

Cumulative GPA:

Major/Program of Study:

Campus Representing

Why did you choose to attend SCC?

Why do you want to be a member of the Presidential Leadership Academy?

What strengths, attributes and talents do you possess that would contribute to your effectiveness as a PLA?

Please list extracurricular activities that you have participated in during high school and/or college:

Please list your two most recent work or volunteer experiences:

Is there anything else you would like us to know about you:

Please provide two (2) references (that are not related to you) to any combination of two SCC faculty and/or staff:

Name:

Title/Position:

Relationship to Applicant:

Phone:

 

Name:

Title/Position:

Relationship to Applicant:

Phone:

 

I certify that all the information provided on this application is accurate, is true, and acknowledge that any misrepresentation and/or withholding of information may result in rejection of this application or may be considered just cause for discharge if discovered after employment begins. I also understand that incomplete applications may not be considered.


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