LEAD Application

Thank you for your interest in the PVCC-Batten LEAD (Leveraging Early Admission) program. Please complete the form below and we’ll be back in touch with you to discuss the program in more detail. 

For more information on the LEAD Program, please visit: https://batten.virginia.edu/lead-program

First Name

Last Name

Preferred First Name

VCCS Email Address

VCCS ID Number

Birthdate

Best phone number to reach you

Are you a Virginia resident?

Yes

No

Have you encountered or experienced significant non-academic circumstances? (Such as having qualified for a waiver of college application fees; being a first-generation college student; eligibility for a federal Pell Grant; having received or currently receiving need-based aid; being from or living in a neighborhood with a high degree of socioeconomic disadvantage; pursuing education as an adult learner; having served in the military, etc.)

Yes

No

I am pursuing the following program at PVCC

Which program are you pursuing at PVCC?

Anticipated PVCC Graduation Date

Estimated number of credit hours completed by the end of this semester

Current cumulative (overall) GPA

Under the Family Educational Rights and Privacy Act of 1974, the written consent of a parent or eligible student is required before the education records of a student, or personally identifiable information contained therein, may be disclosed to a third party, unless an exception to this general requirement of written consent applies. If a student is age 18 years or older, or is enrolled in an institution of postsecondary education, he or she is an “eligible student” and must provide written consent for the disclosure of his or her education records or personally identifiable information contained therein. I understand that I may withdraw this consent to share this information at any time. A request to withdraw consent should be submitted in writing and signed. 

In place of your signature for the above question, please type your full legal name

Please upload a copy of your current unofficial PVCC transcript 

Have you ever been found guilty of an academic, disciplinary, judicial, or honor code violation?

Yes

No

If yes, please provide additional details. 

In a short statement, please tell us how participating in the LEAD Program and attending the Batten School help you meet your academic, professional, or personal goals. 

Feel free to provide us with any additional information you’d like for us to consider.

School