Part 3: Leadership Positions—List all elected or appointed leadership positions held in school,
community or work activities. Include only those positions in which you were directly
responsible for directing or motivating others.
Column 1
Column 2
Column 3
Column 4
Activity
Date(s) Involved
Accomplishments/
Advisor/Coach/Adult
(Can use grade
Positions held
Supervisor’s Name/ Contact
level also)
Information
Part 4: Service Activities— List here your contributions to the school, to classmates, and to the
community through service opportunities:
Column 1
Column 2
Column 3
Column 4
Activity
Date(s) Involved
Advisor/Coach/Adult
Contact Information (Phone number or
(Include hours per
Supervisor’s Name
email) of person listed in column 3
week)