POWERED BY THE JERRY J. DAWSON CIVIC LEADERSHIP INSTITUTE IN MACON COUNTY ILLINOIS

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Student Application to Apply for DCLI Participation

Please complete the following information to start increasing your civic participation.

STUDENT INFORMATION

Please Select:

DCLI PROGRAM INTERESTS

High School Scholars
DCLI College Scholars
Please Select Your Areas of Interest:

DCLI APPLICATION QUESTIONS

Answer the following four questions completely – using full and grammatically correct sentences.

EDUCATOR SPONSOR INFORMATION

When applying for DCLI participation, you are required to be supported by an educator at your school. Please provide the contact information for the person you have selected.

PARENT OR GUARDIAN INFORMATION

We believe that collaboration with parents and family is important to encourage the success of our students. Please complete the following information.

Please note that by signing your are authorizing that photographs and footage of you may be used by DCLI for marketing and publicity in our publications, on our website and in social media or in any third party publication. Please contact us if you have any concerns or if you wish to be exempted from this authorization.

Thanks for submitting!