SUMMER 2025 SCHOLARSHIP APPLICATION-The AGORA

SUMMER 2025 SCHOLARSHIP APPLICATION

The AGORA Leadership Development Program July 7-18, 2025 8:30AM-3:30PM

Participant's First Name

Participant's Last Name

Participant's Date of Birth

Participant's E-mail

Participant's Phone Number

The following 3 questions are to be answered by the participant:

1. How do you define leadership?

2. What are the last 3 books that you read and why did you read them?

3. How do you set goals?

Parent/guardian is required to complete & agree to the section below:

Parent/Guardian's Full Name

Parent/Guardian's E-mail

Parent/Guardian's Phone Number

As the legal parent/guardian:

I grant permission to use the photos/video/sound bites of my child for promotional purposes

I will arrange/provide transportation for my child to and from the program (July 7-18, 2025)

I will submit an updated Medical Form as required by the state of Connecticut

Parent/Guardian Signature