App deadline:
SUNDAY, MAY 27, 2018
Have questions or need help filling out the form?
323-258-6722  •  summits@mpac.org
Let's begin!
 
Please have the following ready before starting the app:

1. Professional or volunteer experience
2. Resume
3. References
4. Personal Statement (500 words)

NOTE: All documents must be in Word or PDF format.
 
Part 1 of 5: Getting to Know You

 
First name *

 
Last name *

 
Cell phone *

Or primary phone.
Format: 000-000-0000
 
Gender *



 
Date of birth *

Enter in MM/DD/YYYY format
 
Current address

 
Street address *

 
City *

 
State *

Two letter abbreviation (example: CA)
 
Zip code *

 
Where did you hear about the MPAC Summits? *


 
Would you like to subscribe to MPAC's email list? *

You will receive approx. 2 emails/week. We do not share your info with anyone.
     
 
Part 2 of 5: Time to Get Academic

 
What's your current academic level? *


 
Name of college or university *

 
Graduation date *

You may enter an approximate date
 
Major *

 
Minor

If applicable
 
Name of graduate school

If applicable
 
Graduation date

If applicable
 
Major

If applicable
 
Part 3 of 5: Work and Life Experience

Tell us about your professional or volunteer experience related to the Summit you're applying for.
 
Organization 1 *

 
Website *

 
Your role or position *

 
Start to end dates *

 
Name of supervisor *

 
Supervisor's phone number *

Format: 000-000-0000
 
Organization 2 *

 
Website *

 
Your role or position *

 
Start to end date *

 
Name of supervisor *

 
Supervisor's phone number *

Format: 000-000-0000
 
Part 4 of 5: Time to Share Some Documents

Please upload Word or PDF files only.
 
Resume *

Limit your resume to 1-2 pages max. Include academic, professional and extracurricular activities and honors. Only upload a Word or PDF file.
 
Personal Statement *

Tell us about you and why you are applying to MPAC's Young Leaders Summits. What are your aspirations and how are you working toward them? What do you want to get out of this experience? How will your participation in the Summits help you on your journey to fulfilling your goals? (500 words max)

Only upload a Word or PDF file please.
 
References *

Provide two professional, academic or community references. Please include a phone number, email and your connection to each person. Only upload a Word or PDF file please.
 
Part 5 of 5: "Sign" on the Dotted Line...

 
I hereby state that the aforementioned information is accurate. In the event that I am selected to participate in an MPAC Summit, I commit to: *

You must agree to all options below.

 
Virtual signature *

Please type your full name below to accept the above terms.
 
Date of agreement *

Enter today's date in MM/DD/YYY format.
Thank you for applying to
MPAC's Young Leaders Summit program.

Our staff will review your application and get in touch shortly.