Legacy Leadership Institute on Public Policy application form 2019
The Legacy Leadership Institute on Public Policy, based in the University of Maryland School of Public Health, is designed to provide residents aged 50+ with new careers as Legacy Service Leaders during retirement. These leaders will receive training and will work with elected officials to help address the challenges facing the state of Maryland. Please submit your application to participate in the 2019-2020 class below. The classroom training will begin September 10, 2019. Learn more and watch a video about the program by visiting: http://sph.umd.edu/legacyleaders

Ready to apply? Please fill out the form below.

Email address *
First Name *
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Last Name *
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Street Address
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City, State
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Zip Code
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County
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Daytime Phone # *
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Evening Phone #
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How did you hear about Legacy Leadership Institute on Public Policy? *
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Briefly describe present/previous employment *
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Briefly describe any special skills
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Are you currently employed?
Do you plan on retiring in the near future?
Approximately when do you plan on retiring?
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Are you currently involved with a volunteer organization(s)?
Please give a brief description
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Please indicate your highest level of completed education
Is there a particular office you are interested in serving in?
Which office?
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References: Please list two (2) people who know you well either as an employee, as a friend, or as a volunteer. (Name, Phone Number, and Email) *
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