International Student Leadership Institute 2025 (if paying with check) Name* First Last Date of Birth*Age*Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Parish Name*Town or City where Parish is located*Name of School*Grade Level (For summer ISLI, student must have completed 9th grade)*Select grade level from drop down menu below9th Grade10th Grade11th Grade12th GradeAny health or dietary needs:Are you a first time participant?* Yes No Gender Male Female Shirt Size Small Medium Large X-Large 2 X-Large Please list any special needs or accomodations you may need in the space below.Who will be responsible for paying registration fee? (Some parishes provide scholarships.)Email Address* Parent/Guardian Name*Parent/Guardian Phone Number*Parent/Guardian EmailRelationship to StudentOpen Ended Questions - Please briefly answer at least two of the questions below.1) What is the biggest challenge you’ve faced this past year and how did you handle it?2) Name an activity/organization you’re involved in and briefly explain your involvement and how both you and the program have benefitted.3) In your own words, define “leadership.” How will developing leadership skills be valuable for your future?4) What aspect of the ISLI program appeals to you the most?Reference Info – Please list the contact information for your reference. References must be over the age of 18 and can honestly attest to your leadership capabilities and potential. Acceptable reference may be Pastors, DREs, Youth Ministers, Teachers, Coaches, or Employers. Based on the information you submit, we will contact your reference on your behalf. However, please make them aware that the Diocese of Scranton will be in contact with them.Name of ReferenceRelationship to StudentEmail address of ReferencePhone NumberISLI Cost: (Fee covers program materials, meals, room and a t-shirt.) ISLI Deposit (non-refundable) - $100.00 ISLI First Time Participants - $200.00 ISLI First Time Participants - $225.00 (After February 20th) ISLI Trainees (second time or third time at ISLI) – $215 ISLI Trainees (second time or third time at ISLI) $240 (after February 20th) • Please make your check payable to the Diocese of Scranton and mail it to: Tommy Flynn, Office for Parish Life, 330 Wyoming Ave., Scranton, PA 18503ISLI Registration Fee Total $0.00 Δ