Red Cross Collegiate Leadership Program
Please upload your signed Student-Leader Agreement Form. Remember all parties must understand, agree and sign to be considered for program.
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Please upload your resume.
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Please upload your unofficial transcript.
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Upload a headshot photo.
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First Name
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Middle Name
Last Name
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Nick Name (if preferred)
Pronouns
Your Email Address
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Your Phone
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Date of Birth
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Are you currently a college sophomore at an college or university?
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Yes
Expected Graduation Date
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Name of college or university you are attending:
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Is this school listed above the main campus or a satellite campus?
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Main Campus
Satellite Campus
In what city is your school located?
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In what state is your school located?
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Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Please enter your school's website.
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Please enter your school's zip code.
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Please enter your student ID
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Major
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Minor
Current Overall GPA
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What sport(s) do you play? (Optional)
Do you have any plans or intentions to transfer before graduating?
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Yes
No
Do you have any plans or intentions to study abroad?
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Yes
No
Country of Citizenship
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State Listed on Drivers License
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What is your closest airport?
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Parent/Guardian Information
Parent/Guardian 1
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First Name
Last Name
Parent/Guardian 2
First Name
Last Name
Parent/Guardian Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian Phone 1
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Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Phone 2
Please enter a valid phone number.
Format: (000) 000-0000.
Please answer the questions below to the best of your knowledge.
Have you ever previously served the American Red Cross as a volunteer or staff member?
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Yes
No
What does the American Red Cross mean to you? Please describe any previous involvement you have had with the Red Cross.
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Describe how your training and development as a student leader has prepared you for this opportunity/leadership role?
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Please provide a one paragraph bio that if you are selected, will appear on the Red Cross website.
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Please leave any notes on accessibility accommodations
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References
List two references other than family members (faculty member, coach, mentor).
First Reference Name
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First Name
Last Name
First Reference Email
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example@example.com
Reference Phone
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Please enter a valid phone number.
Format: (000) 000-0000.
What is the reference's relationship to you?
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Second Reference Name
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First Name
Last Name
Second Reference Email
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example@example.com
Second Reference Phone
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Please enter a valid phone number.
Format: (000) 000-0000.
What is the reference's relationship to you?
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If an athlete, additional contact information needed, for each.
Coach
First Name
Last Name
Athletic Director
First Name
Last Name
If not an athlete, additional contact information needed, for each.
President
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First Name
Last Name
Dean
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First Name
Last Name
Dietary Restrictions
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T-Shirt Size *
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Submit
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