Leaderville UWA

Name
Address
City
*State*		*Zip*
Home Phone
Other Phone
Email
City/School
School Phone
Principal
Best time/place to be reached
*Shirt Size*		High School Graduation Year

Name of Workshop Council Advisor(s):

School leadership experience (number of years, offices held, etc):

Workshop or conference experience (local, state, national):

School co-curricular activities (number of years, leadership positions held):

Community activities and positions of leadership held:

Why do you want to be a Leaderville junior counselor?

How do you perceive your role as junior counselor?

Please include a recommendation(s) from your school council advisor(s) and/or other appropriate person(s) and a recent snapshot (application and/or pictures will not be returned) to leadervilleuwa@yahoo.com *or mail to:*

Leaderville UWA Office of Student Affairs UWA Station 4 Livingston, AL 35470
*DEADLINE: March 15, 2004*
Leaderville UWA would like to have all staff selected and applicants notified by April 7, 2004. If you have not heard and/or need to know if you were selected in order to resolve other summer opportunities and plans, please feel free to call the Leaderville UWA Office at (205) 652-3523 or leadervilleuwa@yahoo.com