Junior Leadership Alcorn Application

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Use tab to navigate through the menu items.

Program open to Sophomores and Juniors

If selected, a $75 fee is required for meals, transportation, and speakers.

First Name

Last Name

School

Current Grade

Address (City, State, Zip)

Cell

Parent(s) or Guardian(s) Name(s)

Parent or Guardian Cell

Parent(s) or Guardian(s) Email

Gender

Date of Birth (mm/dd/yyyy)

Email

Connect with us:

Monday-Friday

8:30 AM - 5:00 PM

502 Wick Street

Corinth, MS 38834

662-287-5269

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