2023-2024 EASL Forum Application

Basic Information
Full Name*

First NameMiddle Initial Last Name
Pronouns
E-mail*
Phone Number*

Area CodePhone Number
School*
Major
Program of Study
e.g., Anthropology, Bioethics, Environmental Health Sciences, etc.
GBS Program of Study

UndergraduateGraduate
Area of Study/Interest
e.g., Early Modern Literature, Health Equity, Immigration Law, etc.
Anticipated Graduation Year*
I live...*

On-campusOff-campus
If selected for the EASL Forum, could you meet on Tuesday evenings from 7:00 - 8:30?*

YesNo
Please list evenings that would work for you.

Short-Answer Questions

Answers should be between 150-300 words.
What interests you most about a program in ethics and servant leadership, and why do you want to participate?*

150 to 300 words max0/300
What experiences have most informed or shaped your understanding of the world?*

150 to 300 words max0/300
What types of questions about leadership, ethics, community, or yourself would you like to explore during your time in the Forum?*

150 to 300 words max0/300

References

List two references who can attest to your suitability for participating in the EASL Forum.
1st Reference
1st Reference Name*

First NameLast Name
1st Reference E-mail*
1st Reference Position/Relation*
1st Reference Phone Number

Area CodePhone Number
2nd Reference
2nd Reference Name*

First NameLast Name
2nd Reference E-mail*
2nd Reference Position/Relation*
2nd Reference Phone Number

Area CodePhone Number

2024 - 2025 EASL Forum Application