Emerging Leaders Application

Part One: Basic Information

* Indicates required field

Name *

First

Last

Phone Number *

Email *

WeChat *

Birthday *

Gender *

If "Other," please elaborate here: *

Pronouns *

If "Other," please elaborate here: *

Home Address *

Line 1

Line 2

City

State

Zip Code

Country

Which of the following best describes you? *

How did you hear about this program? *

If "Other" please explain *

Part Two: School Information

Name of School *

International School? *

Yes No

School Address *

Line 1

Line 2

City

State

Zip Code

Country

Grades Attended *

Primary Language of Instruction *

Guidance Counselor Name *

Guidance Counselor Email *

If you attended a previous high school before your current one, please provide its information below. If not, please proceed to Section Three.

Name of School *

Address *

Line 1

Line 2

City

State

Zip Code

Country

International School? *

Yes No

Grades Attended *

Primary Language of Instruction *

Guidance Counselor Name *

Guidance Counselor Email *

Part Three: Academic Background

Current Grade in School *

GPA (round to nearest tenth) *

Please List All Current Courses You Are Enrolled In. Also indicate course length (i.e. full year, semester, quarter) *

Class Rank (if provided by school) *

Number of Semesters or Quarters Making Honor Roll: *

Note: If you would like to highlight additional academic accomplishments of your school career, please include them in part five.

Part Four: Language Proficiency

Native Language *

Years of Study at an English Language Institution *

If none, how many years of English classes have you taken? *

Please note that all applicants with less than three years of study at an English language institution will be required to take a 20-minute language proficiency test.

Part Five: Open Response

Short Response:

In 100-200 words, please explain how participating program will aid your future career goals. Feel free to reference both personal and academic accomplishments.

Enter Text Here: *

Part Six: Endorsements

Statement of Accuracy: *

By checking this box, I confirm that all information presented in this application and its associated materials is accurate to the best of my ability.

Photo Waiver: *

If accepted to the program, I consent to allow Boston Roundtable to take photographs and video of me participating in the program and use them in web and printed material for the purpose of promoting future Boston Roundtable programming. If accepted to the program, I do NOT consent to allow Boston Roundtable to take photographs and videos of me participating in the program.

WAIT: Before clicking "Submit Application," please double-check that you have filled out all required sections and that self-reported information is accurate and written to your satisfaction.

Submit Application