Online Application

Personal Information:

First Name*

Last Name*

E-mail*  ISU e-mail

Student ID# * 991-  Last six(6) digits

Home Address*  Address Line 1

   Address Line 2

City*

ZIP*

State*   As - IN for Indiana

Home Phone*   As - (xxx)xxx-xxxx

Cell   As - (xxx)xxx-xxxx

Fall Classification* Please select New Freshmen Freshmen Sophomore Junior Senior Transfer

Major*

Minor

What shirt size do you prefer? Please select S M L XL XXL XXXL

Things most important to you:

Please select exactly seven(7) choices that you feel are the most important to you

Problem Resolution:

Reflection Questions:

Community Service:

What volunteer/community service have you been involved with (most recent)?

Organization I

Name of the organization

City

State

Person in charge of activity

E-mail

Work Phone   As - (xxx)xxx-xxxx

Was this activity a fund-raiser? Yes  No   - If yes, how much money did you personally raise 

Brief description of what you personally did at the site

Organization II

Name of the organization

City

State

Person in charge of activity

E-mail

Work Phone   As - (xxx)xxx-xxxx

Was this activity a fund-raiser? Yes  No   - If yes, how much money did you personally raise 

Brief description of what you personally did at the site

Organization III

Name of the organization

City

State

Person in charge of activity

E-mail

Work Phone   As - (xxx)xxx-xxxx

Was this activity a fund-raiser? Yes  No   - If yes, how much money did you personally raise 

Brief description of what you personally did at the site

Commitment to service

If we were to call one of the people listed above, what would they tell us about your commitment to service and how you helped their organization? (Use additional space below in 300-500 words)

No community service

If you have not done any community service please explain why (Use additional space below in 300-500 words)

Important things you want to learn:

In 300-500 words tell us why you are interested in the LLC

Current Skill Levels:

In 300 - 500 words tell us what motivates you to do community service.

Roommate Request

If you have a roommate request, please indicate below, this will only be used if you are accepted into the LLC. Remember only LLC member can live on the LLC floors. Also, indicate your roommate request on your Housing Application/Contract.

First Name

Last Name

E-mail  ISU e-mail

991#

Please provide the following information. It will not be used as part of the selection process, however it will be used to make room and roommate assignments for new members. We will do our best to honor roommate requests and to match roommates.

• Are you conditionally admitted to ISU Yes  No
• Are you an Academic Opportunity Program(AOP) student? Yes  No
• Have you been accepted into the ISU Honors Program? Yes  No
• Will you be in ISU band? Yes  No
• Will you be playing a sport at ISU? Yes  No
• Are you an early riser? Yes  No
• Is the neatness of your room very important to you? Yes  No

By submitting this Leadership Learning Community (LLC) application you are agreeing to the following:

1. If selected, you agree to participate in the LLC for the next academic year.
2. If selected, you agree to live on one of the LLC floors in Sandison Hall (unless noted differently on this application).
3. If selected, you understand that you may be asked to leave the LLC and Sandison Hall at anytime if you fail to meet the LLC expectations which include but are not limited to: being in good conduct standings with ISU, attending LLC weekly sessions, participation in LLC activities and being a good role model.
4. You give permission for Indiana State University to release pertinent information requested by Residential Life. You understand that your grades and conduct records will be checked during the application process and if selected, at anytime during your participation in the Leadership Learning Community (LLC).

 I agree to the above conditions