Lorraine's Leaders Application

Apply to become one of Lorraine's Leaders!

First

Middle

Last

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Student Phone Number

Home Phone Number

Gender Identity

Current School

Current Grade

What languages do you speak?

What are some of your academic interests?

What are some of your extracurricular activities?

Family responsibilities

Paid work

Dance/Music

Art

Sports

Debate

Student government

Community service

Which activities are most important to you and why?

Three words to describe yourself

Do you have any specific STEM (science, technology, engineering, or math) or health sciences interests?

Do you plan on studying a STEM (science, technology, engineering, or math) field, including health care or health sciences after high school?

Are you interested in gaining more hands-on lab experience?

Would you like to learn more about university options available to you?

How did you learn about the Lorraine’s Leaders Program?

​Academics