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
*
January
February
March
April
May
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July
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November
December
Month
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Day
2021
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2019
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2015
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2002
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1931
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1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
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?
Submit
Thank you!
After you submit, we will follow-up with more information and to schedule an interview.
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