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UCONN
UNIVERSITY OF CONNECTICUT
Undergraduate Admissions
In order to provide you with the services and support the University offers as part of its mission and purposes, we at times need to collect, store and/or process certain information about prospective and current members of our University community, as well as our website guests. The University of Connecticut values your privacy and takes the protection of personal information very seriously. We recognize that these efforts require us to secure your information appropriately and to handle it respectfully. We have developed various privacy notices and posted them on the University Privacy Notices webpage at https://privacy.uconn.edu/university-privacy-notices/ to provide information about our data collection and processing practices. These notices will inform you in greater detail about the types of information we collect, how we may use it and how we maintain it based upon the relationship(s) you may have with the University.
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2021 Summer LEAD Program Nomination Form
Thank you for nominating a student for the Summer LEAD Program!
For questions and additional information about the program, please visit admissions.uconn.edu/LEAD, or contact Lawrence Williams at lawrence.williams@uconn.edu.
The deadline for the Summer LEAD Program Nomination Form is
Thursday, April 1, 2021
.
Nominator Information
Nominator First Name
Nominator Last Name
Nominator Title
Nominator School/Organization Name
Nominator Email Address
Nominator Phone Number
How long have you known the student you are nominating?
Why do you feel this student would be a good fit for the Summer LEAD Program?
Student Information
Student First Name
Student Middle Name
Student Last Name
Student Birthdate
Student Birthdate
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Student Email Address
Student Home Phone Number
Student Mobile Phone Number
Student Mailing Address
Student Mailing Address
Country
Street
City
Region
Postal Code
Student Biological Sex
Female
Male
Student Gender Identity
Female
Male
Nonbinary
Other
Trans Female
Trans Male
Is the student Hispanic/Latino?
Is the student Hispanic/Latino?
Yes
No
Student Ethnicity
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific
White
Decline
The University of Connecticut does not discriminate on the basis of race, color, ethnicity, religious creed, age, sex, marital status, national origin, ancestry, sexual orientation, genetic information, physical or mental disabilities (including learning disabilities, intellectual disabilities, past/present history of a mental disorder), prior conviction of a crime (or similar characteristic), workplace hazards to reproductive systems, gender identity or expression, or other legally protected classifications in its programs and activities as required by Title IX of the Educational Amendments of 1972, the Americans with Disabilities Act of 1990, Section 504 of the Rehabilitation Act of 1973, Title VII of the Civil Rights Act of 1964, and other applicable statutes and University policies. The University of Connecticut prohibits sexual harassment, including sexual violence.
Student High School Name
Upload the student's most recent high school transcript (if available).
Submit