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Application Form

Name

Prefix

Legal First Name/Given Name *

Middle Name *

Legal Last Name/Family Name *

Maiden/Other Last Name

Preferred First Name

Birth Information

Date of Birth *

Month

Day

Year

Country of Birth *

City of Birth *

State of Birth *

Citizenship

Citizenship Status *

Dual Country of Citizenship (if applicable)

Applicant Contact Information

Email Address Used to Contact You During the Application Process *

Alternative Email Address *

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Address Expiration Date (if applicable) *

Month *

Day *

Year *

Preferred US Telephone Number *

Permanent Address

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Address Expiration Date (if applicable)

Month

Day

Year

Program Information

Leapman Research Program

Selection Terms

Languages *Please List Your Native Language

Do you speak any other languages? *YesNo

Languages

LanguagesPlease List Any Other Languages

Do you read and/or write any of the ancient languages? *YesNo

Are you the spouse or dependent of someone who is currently serving or who has served in the US Armed Services? *YesNo

Are you currently serving or have you served in the US Armed Services? *YesNo

Ethnicity

In order to fulfill these requests, we ask you to answer the following questions. This information is confidential and completely voluntary and will be concealed from the admissions committee that is evaluating your application. The Leapman Institute does not discriminate with regard to race, color, sex, religion, national origin, sexual orientation or handicap.

Are you Hispanic or Latino (including Spain)? *YesNo

Regardless of your answer to the prior question, please check one or more of the following groups in which you consider yourself to be a member.American Indian or Alaska Native (including all Original Peoples of the Americas)Asian (including Indian subcontinent and Philippines)Black or African American (including Africa and Caribbean)Native Hawaiian or Other Pacific Islander (Original Peoples)White (including Europe, North Africa, and Middle East)

Which best describes your background?

For federal and state reporting purposes, how do you identify your sex?

Would you like to provide information regarding your gender identity and/or pronouns?

Family Background

Do you come from a family with an annual income below established low income thresholds?

Are you, or will you be the first person in your immediate family to have completed a bachelor's degree?

Parent or Guardian Information

Prefix

Legal First Name/Given Name

Middle Name

Legal Last Name/Family Name

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country of Birth

Preferred US Telephone Number

Email Address *

Academic Background

Name of School *

School City *

State/Province

ZIP / Postal Code

Country

Begin Date *

Month

Day

Year

End Date *

Month

Day

Year

List your date of expected high school graduation *

Month

Day

Year

Upload Unofficial Transcript *

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Awards

If you have been competitively awarded any fellowships or other honors, briefly describe

Standardized Tests

Standardized Tests (ACT, PSAT, SAT, LSAT, TOEFL, IELTS)

List Standardized Tests

Standardized Tests Upload file

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Academic Conduct Violation

Have you ever been placed on probation, dismissed, or suspended from any college or university for reasons pertaining to academic integrity or a code of conduct violation? *YesNo

Recommendations

The program you intend to apply for stipulates a requisite minimum of two recommendations, while accommodating a maximum of four

Prefix

First Name

Middle Name

Last Name

Upload file

No file chosen

Personal Statement

Upload a personal statement as directed on the Program Info section of your application. Personal Statement Accepted File Types: txt, pdf, rtf, doc, docx

Upload file

No file chosen

Agreement Statement

Signature *Applicant’s Declaration I affirm that the information provided in this application is accurate and that the statements made herein are my own truthful representations to the Admissions Committee. I certify that all materials accompanying this admission application are exclusively my work or creation, conceived and executed without the aid of any external individual, party, or agency. I acknowledge that the submitted materials are subject to verification. I grant permission to all individuals or entities holding relevant information to share it with The Leapman Institute or its designated representative for the purposes of evaluating my application for admission or verifying the authenticity of the materials I have submitted. I am aware that The Leapman Institute does not inform applicants regarding the details of its verification process. Any misrepresentation, omission, or violation of academic integrity in my application or supplementary materials will be grounds for denial of admission, revocation of admission and/or financial aid, or expulsion if discovered subsequently. I understand that all materials submitted for this application become the property of The Leapman Institute and are non-returnable.

Consent *

Yes, I agree with the privacy policy and terms and conditions.

Phone: ‪1 (202) 681-9178‬
Email: info@leapman.org
Information:info@leapman.org
Admission: admission@leapman.org

Leapman Institute Foundation:
8 The Green Ste B, Dover, DE, 19901

Leapman Institute:
40 Lloyd Avenue, Ste 203, Malvern, Pennsylvania 19355

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