ALP Application

1. Name (last, first, middle initial)

2. Parent/Guardian Name

3. Street Address

4. City

5. State

6. Zip Code

7. Home Phone

8. Applicant's Cell Phone

9. Parent's Cell Phone

10. Applicant's Email Address

11. Parent's Email Address

12. Please select the following:

13. Date of Birth

14. Age (at the time of ALP)

15. Current Year in School

16. T-shirt size
XS S M L XL XXL

17. Height

18. ALP has a backpacking and a canoeing option. La Vida cannot guarantee, but will do its best to place participants in their trip of choice. Please indicate which trip you prefer.

19. Preferred Trip Dates:

20. Why are you interested in the Adirondack Leadership Program?

21. Write a paragraph or more about a leader you want to be like and why.

22. What are two leadership qualities you hope to develop more during the ALP?

23. ALP includes a faith component that will involve time spent in conversation specifically focusing on your own spiritual and faith development. Tell us a little bit about your desire for your own personal faith development on this trip.

24. How did you hear about the Adirondack Leadership Program?

25. Referred By (please list the person who told you about ALP):

26. Please list two people that we may contact as references to your leadership potential and character. Include their NAME, PHONE NUMBER and EMAIL address.

27. Due to the strenuous nature of the activities and remote environment, are there any physical, emotional or mental health concerns we need to be aware of?

28. Are you taking any prescribed medications?

29. Are you allergic to bee stings? (Yes/No/Severity)

30. If yes, do you carry an EpiPen for your bee allergy? (If yes, please note you must bring your own EpiPen in addition to the ones we carry in the first-aid kit.)

31. Do you have any other allergies, especially foods? What foods and how severe?

32. Do you have any special dietary needs? Please check all that apply. (We cannot accommodate food preferences, but we will work with you regarding medical dietary needs. Please contact lavida@gordon.edu)

33. I have read and agree to the ALP cancellation policy and graduated fee refund schedule. Please see above for details on the cancellation policy and graduated fee schedule.

34. The above information is true and written by the applicant for the ALP.

35. As a program of Gordon College, we may send you information regarding the school. If you wish to not receive these mailings, please indicate that below.