Design Your Success™- Application for Admission

Personal Information

Legal Name

Please enter your name as it appears on your driver’s license and other official documentation.

First Name

Middle Initial

Last Name

Preferred Name

Date of Birth

Permanent Address

Street Address

City

State

Zip Code

Country

Contact Information

Mobile Phone

Secondary Phone

Additional email address(es) for program notifications

Please separate multiple addresses with a comma.

Program Interests

Briefly describe your interest in the Design Your Success™ program.

100 word maximum

Which part(s) of the program are you applying for? (Check both for the full-year program.)

Part I: Discovering Individual Leadership & the Growth Mindset (Sept 14 – Dec 18, 2020)

Part II: Developing Creativity, Design Thinking & the Entrepreneurial Mindset (Feb 1 – May 7, 2021)

Please rank order your general scheduling preferences for participation in weekday (M-F) discussions, workshops and other program activities.

First Choice

Second Choice

Third Choice

Fourth Choice

List any areas of personal or professional interest. (For example, marketing, music or mechanical engineering.)

Eligibility to Participate

Please list one 2- or 4-year College or University to which you were accepted for Fall 2020 admission or in which you are currently enrolled.

Attach a scanned copy of your acceptance letter/notification, current student ID or some other form of documentation to show you'll be foregoing full-time studies to participate.

Preferred format: svg, ai, eps, pdf, png, gif NO jpeg

Need for Financial Assistance

The program fee schedule ($4950 for the full year, $2725 for half-year) was set to provide exceptional value to all participants. However, limited financial assistance will be offered to those for whom participation would not be possible without a fee reduction. Please check the box below if and only if you will need financial assistance to participate in the program.

I will not be able to participate in Design Your Success™ without financial assistance.