Apply TodayDate of Application* MM slash DD slash YYYY Name* First Middle Last Home Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Employer Name*Employer Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Your Title*Phone*Work Email* Personal Email* Which email do you prefer we use when contacting you?* Work HomeWhy are you interested in the McLeod For Tomorrow Leadership Program?*Tuition is $550This includes your training, meals, refreshments, bus transportation when needed, and supplies. Tuition payment will be due upon your acceptance into the program. (Note: Scholarship dollars are available. Please let us know if you would like more information.)Who will be paying your tuition?* Self Employer OrganizationTo the attention of: (Supervisors name and email)NameAddress Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Additional InformationThe Selection Committee strives to recruit candidates from a representative cross-section of McLeod County. Participants will be chosen by the Committee based on application information submitted by program candidates.Age Group* 20-30 31-45 46-59 60 and overNumber of years you have lived or worked in McLeod County:*Whichever is longer.GenderHiddenGender: Male Female Prefer Not to AnswerRace: African American Asian Pacific Native American Latino/Hispanic White/European Current and past community involvement and volunteer experiences:*OrganizationRoleService Dates Program CommitmentYour signature on this application means you pledge to attend all nine full-day sessions and the half-day civic project session during your program year. In addition, the following program year, we engage participants in planning and hosting a session, which is an additional full-day commitment. Please be sure your employer is aware of the time commitment, as appropriate.Signature*Date* MM slash DD slash YYYY NameThis field is for validation purposes and should be left unchanged.Δ
