STUDENT Application

To expedite your admission please complete the student application form below.

* denotes required field.

First Name:  *
Last Name:  *
Gender: Female Male
E-mail:  *
Cell Phone:  *
Date of Birth:
Current School:  *
Current Grade:
(Enter Cumulative GPA or Weighted Average below)
GPA:  *
List the leadership position(s) you have held:
Please explain your interest in holding these positions:
List the community or volunteer activities in which you are involved:
What motivated you to become involved in these activities:
How many hours do you contribute to these activities weekly:
How did you learn about the W.E.B. Du Bois Society?

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1. Contact us by phone
2. Send a check
3. Make a donation online

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