Indiana Leadership Program: Application: Undergraduate: Forms: Paul H. O’Neill School of Public and Environmental Affairs: Indiana University Bloomington

I. Applicant Information

Last Name*

First Name*

Pronouns

Preferred Name

Student ID*

IU Email*

Phone*

Bloomington Address

Street*

City*

State*

Zip*

Permanent Address Same as Above

Street*

City*

State/Province*

Country*

Zip*

Have you ever had a criminal conviction, including a misdemeanor or felony, or had a civil judgment rendered against you?*

Yes No

If you answered yes, please explain

Have you ever had an IU Academic Misconduct or Personal Misconduct violation?*

Yes No

If you answered yes, please explain

III. Academic Information
Expected Grad. Date*
Do you plan to pursue a major and/or minor at the O’Neill School?* Yes No
Degree(s) Pursued
Major(s)
Minor(s)
Certificate(s)
Cumulative GPA
O’Neill GPA (this can be found on your Academic Advising Report)
Are you an international student? International students will need to receive proper work authorization before starting their internship. The O’Neill School and OIS will be available to guide students through this process.* Yes No
Have you taken V252/H267: Career Planning & Development? Yes No
Are you intending for this internship to count for course credit for V381: Professional Experience (O’Neill internship requirement)? Yes No
Are you intending for this internship to count for elective credit? Yes No
I do not need this internship to count for credit. Yes No
Did you receive the Indiana Leadership Award upon your direct admission to the O’Neill School? (Receiving this award is not a requirement to participate in the Indiana Leadership Program.) Yes No
How did you hear about ILP?

Indiana Leadership Program: Application