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Act Six Academy Application

Legal First Name (required)

Preferred First Name

Last Name (required)

Date of Birth (required)

Address (required)

City (required)

State (required)

ZIP/Postal Code (required)

E-mail Address (required)

I affirm I have been admitted to Whitworth University for fall 2014 and am eligible for the Act Six Academy Program: (required)

Please answer each of the following questions in 150 words or less.

How do you think you will benefit most from the Act Six Academy program at Whitworth? (required)

How will your background, experiences and gifts support Whitworth's commitment to diversity, equity and inclusion? (required)

Describe what effective leadership looks like to you and how you have exercised that leadership in your life. (required)

Please provide the name, phone number and email address of two references and their relationship to you. References can be teachers, counselors, pastors, employers, coaches or other non-relatives who know you well and can speak to your ability to succeed as a Whitworth Academy member.

Reference 1's First Name (required)

Reference 1's Last Name (required)

Reference 1's Phone (required)

Reference 1's E-mail Address (required)

Reference 1's Relationship to You (required)

Reference 2's First Name (required)

Reference 2's Last Name (required)

Reference 2's Phone (required)

Reference 2's E-mail Address (required)

Reference 2's Relationship to You (required)