2018 Pittsburgh Leadership Symposium Application

Student Information
1.  Please complete the application below to register for the 2018 Pittsburgh Leadership Symposium. For more information on the program, visit https://www.billofrightsinstitute.org/engage/students-programs-events/student-leadership-symposiums/.
2.  The red * means that the field is required.  

To comply with legal requirements, we must ask for your birthdate.
School Information

Please enter a 4-digit year (example: 2015)

Parent/Guardian Information

Referring Teacher Information
Please include the contact information for a social studies teacher (history, government, civics, economics, etc.). We may contact this teacher to provide a reference for you.

Need assistance with this form?