Legacy Application

Name: Men of Change Exhibit Opening
Start: 2023-09-16T08:00:00+00:00
End: 2023-12-02T17:00:00+00:00
Location: Birmingham Civil Right Institute

Contact Us

General Information
Name*
First Last
Gender*
Pronouns
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Phone*
Date of Birth*
Month
Day
Year
Education Information
School Currently Attending*
Grade Level*
Homeroom Teacher
Alternative Classes (gifted, special ed. etc.)
Extra-Curricular Activities
Awards Recognition
GPA
Parent/Guardian Information
Parent's Name (1)*
Daytime Telephone*
Cell Phone
Parent's Name (2)*
Daytime Telephone*
Cell Phone
Signature
Signature*
If accepted I agree to fully participate and commit to Legacy Youth Leadership Program
Date
Month
Day
Year
Parent/Guardian Signature*
Date
MM slash DD slash YYYY
Student Information
Please type a 1-2 page double-spaced essay covering each of the following:
Check-off list: Due Friday, February 17, 2023
Check Off list (all documents required to complete application)*
- Completed Application Form
- Typed Essay
- Transcript (sealed if mailed or dropped off)
- Letter of recommendation (sealed if mailed or dropped off)
Hidden
Questions?
Email Michelle Craig at mcraig@bcri.org or call 205-328-9696, extension 235.
Questions?
Upload Transcript
Max. file size: 2 MB.
Upload Letter of Recommendation
Max. file size: 2 MB.
Address and Contact
520 Sixteenth Street North Birmingham, AL 35203 Attention Michelle Craig, mcraig@bcri.org 205-328-9696, extension 235

Legacy Application

LEGACY APPLICATION

Contact Us

General Information

Education Information

Parent/Guardian Information

Signature

Student Information

Check-off list: Due Friday, February 17, 2023

Address and Contact

Upcoming Events

Men of Change Exhibit Opening