FULL LYF Application

Georgia State University Full Leap Year Fellow Application

Please complete the form below if you have NOT YET been accepted into Georgia State University (GSU). If you already have been accepted into GSU, please complete this shorter application: https://form.jotform.com/202896427135157
Full Name *

First Name Middle Name Last Name
Email Address *
example@example.com
Cell Phone Number *
Current Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Are you a US citizen? *

Yes No Other
What high school do you attend? *
What is your GPA? *
Did you participate in an IEP program in high school? If so, please provide details on why you are enrolled and what the focus areas are. *
Which of the below are you most interested in for your future? *

I'm not really interested in going to college, I just want to get a job somewhere Trade Certificate (1-year diploma, ex cosmetic, electrical, hair, automotive, etc.) Associates Degree (2-year degree, ex Georgia Perimeter) Bachelor's Degree (4-year degree, ex Kennesaw State University, etc.)
Birth Date *

Month Day Year
How do you identify? *

Female Male Other
How do you identify? *

Black/African American Latinx/Hispanic Asian Native American White Other
Are you a first-generation college student (ie neither of your parents completed a bachelor's degree)? *

Yes No
Have you or your family participated in any of the below programs in the last three years? *

SNAP/Food Stamps Free and Reduced Lunch Section 8 Social Security Disability Medicaid None of the above
Why do you want to be a Leap Year Fellow? What do you hope to gain from the program? Be sure to write in complete sentences. *
How did you hear about Leap Year? *
Any questions about the Georgia State University Leap Year Fellow program?
Thank you!

After you submit, we will follow-up with more information and to schedule an interview.
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Georgia State University Full Leap Year Fellow Application

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