A CIT Service
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Please enter your First Name
Please enter your Middle Initial (if applicable)
Please enter your Last Name
Please enter your student ID
Eastern E-Mail Address
Please enter your official Eastern e-mail address
Contact Phone Number
Please enter a contact phone number where you can easily be reached
Current Class Rank
Number of credits completed by this semester’s end
Please enter the number of credits you will have completed at the end of the current semester.
Are you a residential student or are you a commuter?
Please use the drop down menu to choose one answer
What is your major/minor?
Have you previously participated in any leadership development programs or training?
If you answered "yes" to the previous question, please describe the program or training in which you participated.
Skip question if answered "no" to the previous question
Please list any on-campus and off-campus leadership positions that you have held.
Why would you like to be selected to participate in the LEAP Program?
Which tier of the LEAP program would you like to apply for?
Your choices are Tier 1-New Student Leader Series Tier 2-Engaged Student Leader Series Tier 3-Advanced Student Leader Series
Please provide name, title, phone number and email of two professional references.
83 Windham Street, Willimantic, Connecticut 06226 USA
Phone Number: (860) 465-5000