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Application for Admission

 Application for Admission

 
Please indicate the institute to which you are applying:
 
(__) One Week LDI Policy Lab -$450 - June 17 – June 23
(__) One Week LDI Policy Lab Commuter Option--$150-June 17 -June 23
(__) One Week Future Champions Policy Lab -$450 – June 17 – June 23
(__) One Week Lincoln-Douglas Lab --$450 – June 17 – June 23
(__) One Week Home School Rhetoric & Debate Lab - $450 - June 17 - June 23
(__) One Week Home School Rhetoric & Debate Lab Commuter Option- $150 - June 17-June 23

(__) Two Week LDI Policy Workshop -$875 - June 17 - June 30
(__) Two Week Lincoln-Douglas Lab - $875 - June 17 - June 30

(__) Three Week Virginia Scholars Lab -$1,275 - June 17 - July 7 (Advanced debaters only)
 
Name______________________________________________________
                        Last                              First                 M.I.    
 
Address____________________________________________________
                        Number                                  Street               Apt. #
 
              _____________________________________________________
                        City                              State                 Zip
 
Phone____________________________       Gender (Circle One)   F     M
                        (Area Code)   Number
 
Date of Birth_______________________
 
E-mail address: ________________________________________
 
Name of Parent or Legal Guardian: ______________________________
           
Parent or Legal Guardian’s Daytime Phone: _______________________                                                                                                           (Area Code)                   Number              
 
T-Shirt Size (Circle One)   S     M     L     XL     XXL
 
Grade Level 2012-13 (Circle One):    9      10      11     12
 
School Name_______________________________________________
 
School Address_____________________________________________
                                    Number                       Street
                          _____________________________________________
                                    City                              State                   Zip
Coach or Director __________________________________________
 
School Phone_______________________________________________
                                        (Area Code)         Number
Previous Institutes
                        (2010)  ______________________      (2011) _______________
 
Institute Instructors
                                    (2008)______________________      (2009) _______________
 
Special Dietary Needs: ______________________________________________
 
APPLICANT’S DEBATE RECORD
 
I.    Please indicate your total win/loss record for each of the following years when applicable. Indicate the division in which most occurred (V = Varsity, JV = Junior Varsity, N = Novice).
 
2010-2011       Total Wins_____   Total Losses_____   Division_____
2009-2010       Total Wins_____   Total Losses_____   Division_____
2008-2009       Total Wins_____   Total Losses_____   Division_____
 
II.   Please list your complete tournament by tournament preliminary and elimination round record for the 2011-12 debate season. Estimate the number of teams at each tournament in your division.
 
 1. ________________________________________________________________
     (Tourn. Name) (Division) (# of teams) (Prelim Record) (Elim Record) (Speaker Award)
 
 2.   _______________________________________________________________
 
 3.   _______________________________________________________________
 
 4.   _______________________________________________________________
 
 5.   _______________________________________________________________
 
 6.   _______________________________________________________________
 
 7.   _______________________________________________________________
 
 8.   _______________________________________________________________
 
 9.   _______________________________________________________________
 
10. ________________________________________________________________
 
11. ________________________________________________________________
 
12. ________________________________________________________________
 
13. ________________________________________________________________
 
14. ________________________________________________________________
 
Please return this application and your non-refundable $100 deposit by June 5, 2012
For payment by check, send it to:
 Liberty University Debate Institute ·Liberty University · 
1971 University Blvd.· Lynchburg, VA 24502-2269
Or by Credit Card fill your information below:
Name as it appears on Credit Card: _________________________________________________________
Credit Card Number: _______________________________________________________________________
Credit Card Expiration Date: __________________________ Credit Card Type: ___________________