Personal Information:

Name:

College/University:

Permanent address

Campus address (if different than your permanent address):

Home phone: Campus phone:

Email:

Perferred address for mailing:   Permanent     Campus

College class/yr:

Major/minor:

Academic areas of interest:

         _ _ _ _ _  _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
 
         Personal Background: (Completing this section is completely voluntary.)

Age:    18-22    23-29    30-39    40+

Ethnicity: African-American   Asian   Caucasian   Latina  
              Other   specify:
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

    
Essay Questions:

Describe political or community activities and/or organizations you have been involved with. Which is most important to you and why?

Why do you wish to participate in NEW Leadership New Jersey? What do you expect to get out of participating in this program?

Please list any honors or awards received, as well as leadership positions attained.

References:

Please include the names, titles, phone numbers and e-mail addresses (if available) for three references:

1.
 
2.
 
3.

 

So that we can improve our program outreach, please tell us where you heard about NEW Leadership.

 

Date: