Application

All fields marked with "*" are required.

Name	*
Home Address	*
Home Address 2
City	*
State	*
Zip	*
Home Phone	*
Parent E-mail address	*
Student E-mail Address	*
Name of High School	*
High School Address	*
High School Address 2
High School City	*
High School State	*
High School Zip	*
High School Principal	*
Year in School as of Fall 2012	*
Class Rank and/or GPA	*
How did you find out about LIFE?
Please comment on your motivation for participating in the workshop, the types of business experience you have had, your computer literacy and your plans after graduation*
By completing this form, I understand that my application is not complete until a letter of recommendation is submitted on my behalf.

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Susquehanna University

514 University Avenue

Selinsgrove, PA, 17870 United States

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