Do you want to be a part of a community

that pushes you to be your best?

Do you have curiosity, motivation to grow,

and the desire to pursue your dreams?

Apply Here!

This application is due on March 6, 2019

Please return it to your counselor or the North Star Office

Parents and Students are STRONGLY ENCOURAGED to attend

a short orientation and introduction to Lead Up

February 19 at 6:00 p.m.

North Star High School

Questions?

Email: Julie@leadupne.org

402-770-1499

Ready for College ― Ready for Career

Section I. APPLICANT INFORMATION

Student’s Name:

First Middle Last

Home Address:

Street

_______________________________________________________________________________

City State Zip Code

Student Contact Information:

Phone#: _____ - _____ - _________

Email:______________________ ____________________ _

What is the best way to reach you? Circle one: Email Text Call

Gender: (Circle One)

M F

Date of Birth:

/ / (Month) (Day) (Year)

Grade/HS Grad Year

Parent/Guardian Contact Information:

Name(s): _______________________________________________

Phone#: _____ - _____ - _________

Parent Email: ______________________________________________

What is the best way to reach you (parent)? Circle one: Email or Phone

2018-19 application pg 2

Section II. ACADEMIC

1. What are you particularly proud of as a student?

2. What do you think you need to do to become a stronger student? Describe what you need to do or

change to become the best learner you can be.

3. When you think about being a stronger student, what areas do you want help with?

Big picture goals; finding out what I’m interested in for the future.

Small picture goals; staying motivated to complete assignments on time

Managing my time my effectively

Feeling positive about my academic abilities

Concentrating during class and study

Organizing facts, figures and ideas I am trying to learn

Understanding and remembering what I read

Learning study skills and study habits that work

Preparing for tests

Becoming a better writer

Enjoying reading for fun

4. Do you seek out teachers or tutors when you need help? Why or why not?

2018-19 application pg 3

Section III. LEADERSHIP

1. What qualities make a great leader?

2. Tell us about a leader or leaders who inspire you. Why?

3. Why is becoming a leader important to you?

2018-19 application pg 4 Section IV. YOU

1. What activities are you involved in either in or outside of school?

2. What activity, hobby, club or interest have you always wanted to try?

3. What career and college interests are you interested in exploring.

4. Name a teacher who can tell us more about your potential and what makes you unique.

2018-19 application pg 5

Last Question!

Describe something about the world that you would like to change. It could be something local

or global….big or small.

I certify that the information provided in this application is true and complete to the best of my ability. If accepted into Lead Up, I agree to participate fully in the program and work to realize my full potential.

Student Signature Date

2018-19 application pg 6

Ready for College ― Ready for Career

FOR PARENTS

UNDERSTANDING OF PROGRAM COMMITMENT:

Please read and initial each statement below:

o I understand that my child’s acceptance into the program is a long-term commitment from program enrollment through college completion.

o I understand that Lead Up is a comprehensive program that includes after-

school, weekend, and summer commitments by the students selected for the

program. Student Leaders will have the opportunity to travel out-of-state during

some program years.

o I understand that Lead Up is a commitment of time on behalf of the family as

well as the student leader and that I will support my student’s participation in activities

and attend 2 mandatory parent meetings per year.

I certify that the information provided in this application is true and complete to the best of

my knowledge. I give permission for my child to be considered for admission to Lead Up.

Parent Signature Date