Liberty National Life Leadership Academy


  1. Fill out the online application by supplying all required information.
  2. Your Agency Owner (Director for SEAL Team) must approve your application before you submit to the Home Office.
  3. Check the box stating you have your Agency Owner’s (Director for SEAL Team) approval.

Once submitted the application goes for approval. The Home Office sends a notification to your Agency Owner (Director for SEAL Team), stating the Home Office received your application.

* Required

Your Name *

Agent Number *

Title *

Agency Owner *

Agency Owner E-mail Address *

Home Address

Street Address *

Street Address Line 2



ZIP code


Cell Phone

Office Phone

Your Email *

Must be your email address.

Hire Date

Length of time in current position



Agency FYA net submit year-to-date

Personal 4-week net submit average:

13-week net submit average:

Team Production 4-week net submit avg:

13-week net submit average:

Agency Production 4-week net submit avg:

13-week net submit average:

# of Agents on your team:

# of Agents in your Pipeline:

What are your goals as an Owner:

What areas would you think are most important to cover in the meeting?

By checking this box I confirm I have received my Agency Owner’s approval to apply for and attend the Liberty National Leadership Academy and that he/she is aware that I am submitting this application.