Apply TodayDate of Application* MM slash DD slash YYYY Name* First Middle Last Preferred nameIf different than your legal first nameHome Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Employer Name*Employer Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest 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 $600This includes your training, meals, refreshments, bus transportation when needed, and supplies. Tuition payment will be due upon your acceptance into the program. Once payment is received there is NO reimbursement or exchanges available. (Note: Scholarship dollars are available. Please let us know if you would like more information.)Who will be paying your tuition?* Self EmployerTo the attention of: (Supervisors name and email)NameAddress Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest 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 overEducational Background Other High school diploma or GED Some college Associates degree or certificate Bachelors degree Master's degree or higher advanced education Prefer not to sayThis is utilized only for diversity of class participants and is not used for selection purposes.Number 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 Veteran Status:No, I have never served.Yes, I am a Veteran.Yes, I am currently serving.Are you a current or former veteran of the United States Armed forces? This includes active duty, reserves, national guard, etc.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. If you need additional information, concrete dates or anything else to show your employer, please reach out to us at [email protected]Signature*Date* MM slash DD slash YYYY PhoneThis field is for validation purposes and should be left unchanged.Δ
