Briefly describe any scholastic distinctions you have earned.
Extracurricular and Personal Activities
Please list your principal extracurricular, community, church, work and family activities. Include specific events and/or major accomplishments such as musical instruments played, varsity sports participated in and honors earned. Please indicate “x” in the left-hand column if you wish to pursue the activity in college. Use an additional sheet if needed or submit a resume.
Please list all colleges at which you have taken courses for credit. An official transcript should be sent from each.
Name of college
Location (City, State)
Scores from the SAT I or ACT are required for admission to CBU or Union University. Scores you have already received should be reported by your school in Part 4. If your school has not received results by the January 16 deadline, you may still apply for Excel but a copy of the exam score report must be received by the Excel office no later than January 20.
Is your school reporting an SAT I or ACT score for you in the Part 4 School Report?
If not, what date will you take a test?
By what date will you send Excel your score report?
Have you been convicted of a felony or gross misdemeanor or do you have a court case pending against you at this time? If yes, please attach written explanation with your application.
Have you ever been found responsible for a disciplinary violation at an education institution you have attended from 9th grade forward, whether related to academic or behavioral misconduct that resulted in your probation, suspension, removal or expulsion from the institution? If yes, please attach written explanation with your application.
Applicant and Parent/Guardian Certification
By our signatures on this form, we certify that:
To the best of our knowledge, all statements made in this application are complete and true. We understand that if at any time information in this application is found to be false or inaccurate, it is sufficient cause for rejection or dismissal from Excel.
The essays accompanying this application are the applicant’s own work, although they may have been reviewed by parents, teachers, or other advocates.
By our signatures on this form, we understand and agree that:
The information submitted on this form will be reviewed by staff at Memphis Leadership Foundation, Union University or CBU and local community-based selection committee members, and outside consultants for the purposes of selection.
Excel is committed to increasing knowledge regarding higher education opportunity through research. I may be contacted by Excel staff or outside consultants in the future and asked to participate in research surveys whether or not I am selected for the program.
By our signatures on this form, we consent to:
Allow any and all information from this application and from other program-related documents that we may complete to be used with Excel research activities. We understand that findings from research activities may be made available to the public in an aggregated form, though never in a form that would allow the applicant to be identified.
Grant the Memphis Leadership Foundation and all Excel partner colleges and universities permission to use photographs and video taken of the applicant during participation in Excel activities for editorial and promotional purposes in any print or electronic media.
Release Excel, the Memphis Leadership Foundation Union University or CBU and their respective directors, officers, agents, and employees (collectively “the Releasees”) from liability for any loss, damage, injury, or illness resulting from the applicant’s participation in events sponsored by Excel (including, but not limited to, all program activities and all provided transportation). We promise that we will not institute, prosecute, or in any way aid in the prosecution of any claim, demand, action, or cause of action against any or all of the Releasees.