IMPACT Student Leadership Application 2024

IMPACT Student Leadership, through the Hartselle Area Chamber of Commerce, is a program designed to promote classroom and community leadership among high school students in Morgan County, Alabama. IMPACT is open to all 10th and 11th-grade students in Hartselle City and Morgan County Schools. IMPACT was created to grow life-long community leaders in the Hartselle area through mentorship, experiential and peer learning, community networking, service projects, and problem-solving opportunities. IMPACT aspires to contribute to the development of citizens that are aware of the building blocks to a strong community, can identify opportunities, understand their individual impact, and have the tools to produce change.

Student Name

First Name *

Last Name *

Date of birth *

Please use MM/DD/YYYY format.

Home Address

Address Line 1 *

Address Line 2

City *

Zip/Postal Code *

Home Phone *

If no home phone is available, please enter your cell phone number.

Cell Phone *

Student Email address *

Please enter an email address that you will use for program communication and check regularly.

Parent/Guardian 1

First Name *

Last Name *

Parent/Guardian #1 Email address *

Please enter an email address that you will use for program communication and check regularly.

Parent/Guardian #1 Phone Number *

Parent/Guardian 2

First Name

Last Name

Parent/Guardian #2 Email address

Please enter an email address that you will use for program communication and check regularly.

Parent/Guardian #2 Phone Number

Shirt size *

Please enter your shirt size as S, M, L, XL, 2XL.

Name of High School *

Hartselle City or Morgan County Schools sophomores or juniors are the only eligible applicants for IMPACT Student Leadership. This includes Hartselle High, Brewer High, Priceville High, Danville High, and Falkville High schools.

What is your current grade level? *

Hartselle City or Morgan County Schools sophomores or juniors are the only eligible applicants for IMPACT Student Leadership. Please respond with Sophomore or Junior.

GPA *

You must provide a copy of your transcript or most current report card.

Upload of your most recent report card. *

Have you ever received any awards or special recognition from your school? If so, please list those.

Do you participate in any sports, school clubs, volunteer groups, or other organizations? If so, please list those.

Do you have a part-time job or co-op? If so, would your work schedule prevent you from attending IMPACT Student Leadership?

If you could change one thing in your school or community, what would it be and how would you change it? *

In four sentences or less, share why you want to be a part of IMPACT Student Leadership. *

By typing your name below, you agree to participate in the program and understand 100 percent attendance is expected if you are selected to be a part of the program (excused absences will be provided to your school administrator). *

By typing the names of your parents/guardians below, you acknowledge they are aware you are submitting this application, you will be traveling during the program on progam buses, and you will be absent from school on program days (excused absences will be provided to your school administrator). *

IMPACT Student Leadership Application 2024

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