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Ivy Leader: Leadership Development Programs for Teens

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- Summer: Dartmouth – South Africa
- Thanksgiving Week: Middle School Program
  - Program Information
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Leadership-development programs for students that combine training at Dartmouth College* with domestic and international service-learning opportunities.

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Ivy Leader Application Form

Once you have decided to apply to the Ivy Leader program, the first step is to fill out this application form. We are looking for motivated students who demonstrate maturity, enthusiasm, and leadership potential. The earlier you apply, the better your chance of acceptance.

STUDENT INFORMATION
Select Program:
- Summer Program (Dartmouth and South Africa)
- Thanksgiving Week Grades 6-9 (Dartmouth)
Name(Required)
First Last
School Name(Required)
Current Grade(Required)
Primary Phone Number
Phone Type(Required)
- Mobile
- Home
- School
Primary Email Address(Required)
Citizenship(Required)
PARENT / GUARDIAN INFORMATION
1st Parent or Guardian Information
Name(Required)
First Last
Relation to Student(Required)
Home Address(Required)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Primary Phone Number
Phone Type(Required)
- Mobile
- Home
- Work
Alternate Phone Number
Phone Type
- Mobile
- Home
- Work
Primary Email Address(Required)
PARENT / GUARDIAN INFORMATION
2nd Parent or Guardian Information
Name
First Last
Relation to Student
Home Address
- Home Address is same as above
Home Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Primary Phone Number
Phone Type
- Mobile
- Home
- Work
Alternate Phone Number
Phone Type
- Mobile
- Home
- Work
Primary Email Address

Ivy Leader™, LLC
PO Box 370
Canaan, NH 03741

(603) 727-2028
rsinclair@ivyleader.com

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*Dartmouth College is not a sponsor or co-sponsor of this program.

Ivy Leader Application Form

STUDENT INFORMATION

Summer Program (Dartmouth and South Africa)

PARENT / GUARDIAN INFORMATION

PARENT / GUARDIAN INFORMATION