2. Description:
   The following topics have been selected by the Michigan City Human Rights Commission because they are relevant in our society today and they encompass some of the basic principles of human rights. Please select one of the following topics for your essay.
4. 1. If there was one thing you could change about your High School Experience. What would you change? And why?
5. 2. The 2016 Election-What surprised you about the election and how did it make you feel?
7. Applicant's First Name*
8. Applicant's Last Name*
10. Applicant's Street Address*
11. Suite or Apartment Number
13. Applicant's Mailing Address
    (if different from street address)
15. City*
16. State*
17. Zip Code*
19. Primary Phone*
20. Secondary Phone
22. Primary Phone Type*

    1. Home
    2. Work
    3. Mobile
23. Secondary Phone Type

    1. Home
    2. Work
    3. Mobile
25. Applicant's Email Address*
26. Fax Number
28. Parent/Guardian's First Name*
29. Parent/Guardian's Last Name*
31. Name of School*
32. Graduation Date*
    Graduation Date
34. School Address*
35. Suite or Apartment Number
37. City*
38. State*
39. Zip Code*
41. Principal's Name*
42. School Telephone*
44. Required Essay*
    Please see topic questions listed at the top of this form.
46. Explain your future educational plans*
    For example: college, vocational training, etc.
48. Please list your community service involvment*
50. Please list your current extracurricular activites*
52. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
54. Electronic Signature
Leave This Blank:


56. 1. Receive an email copy of this form.
57. Email address

    This field is not part of the form submission.

58. Submit Submit and Print

* indicates a required field