Interdisciplinary Certificate in Leadership & Service

Application to the ICLS Program

Fill out the form below and click submit. This will be sent directly to the program coordinator.

Note: For essay answers, you may want to work in a word-processor, then copy-and-paste your answers into this form.

Name:
Address: Include street, city, state, and zip code.
Home Telephone:
Work Telephone:
Cell Telephone:
Email Address:

UGA "810": (last 9 digits on your UGACard)
College:
Advisor:
Major:
Career Objective:
Class:
GPA:
Expected Date of Graduation:	Semester: Year:

Describe your participation in the following activities:

Leadership Programs: e.g. school, student government, 4-H/FFA officers' training
Clubs & Activities: List leadership positions you have held or currently hold.
Community Service or Volunteer Activities:
Employment History:
Goals: What are your goals in working toward the Interdisciplinary Certificate in Leadership and Service?