Leading in Community Application

Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone*
ex: (516)877-1234
Work Phone*
ex: (516)877-1234
Email Address*
Employer*
Salary*
Years Employed in the Nonprofit Sector*
Years of Experience in Community Leadership*
Degrees Held*
How Did You Hear About Leading in Community*
- Email Blast
- Personal Call
- Word of Mouth
- Ad in Newspaper
Why are you interested in applying for the Leading in Community Certificate Program?*
Provide a brief biography including educational background, work, community leadership, and volunteer history. The biography should articulate your personal goals for leadership and what you hope to gain from this program. (300 word limit)*
You may also attach a resume.*
Accepted file types: doc, txt, rtf.
Acceptable file formats: .doc, .txt, .rtf
Are You Interested in Applying for a Scholarship?*
- Yes
- No
Scholarship decisions will be based primarily upon financial need, with some consideration also given to past and current participation in the community, and future leadership potential. To apply, please attach a statement concerning your financial need, involvement in the community and/or how you hope to benefit from your participation in LIC. (200 words)
Accepted file types: doc, txt, rtf.
Acceptable file formats: .doc, .txt, .rtf
*
- By checking this box you are affirming the accuracy of your statements contained within this application.