Leadership Harrison County 2019-20 Application (Adult Class)
Please complete this application to be considered for the LHC class of 2020. Questions? Visit us at www.LeadershipHarrisonCountyIndiana.org or contact executive director Nathan Broom at 812-572-1932 or nathan@LeadershipHarrisonCountyIndiana.org
Email address *
First and last name *
Your answer
Birth date
MM
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DD
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YYYY
Home address *
Your answer
Cell phone
Your answer
Employer
Your answer
Occupation *
Your answer
Employment address
Your answer
Highest level of education
Number of years working in Harrison County
Your answer
Number of years residing in Harrison County
Your answer
Community involvement *
In what ways are you currently involved in the life of your community?
Your answer
Reasons for wishing to participate *
Describe why you would like to be a participant in this program, what you feel is your responsibility to the community, and how you hope to use the leadership skills acquired from this program.
Your answer
Who will pay your tuition? *
Tuition for participants is $450 for applications submitted by July 1st, or $500 after July 1st. Our program is supported by community sponsors and active fundraising, and costs us more than $2000 per participant to deliver.
Do you intend to apply for a partial scholarship?
We have up to four scholarships available, up to a value of $250 each. They are available to self-pay participants with financial need. There is a separate scholarship application available on our website for those who choose to apply.
Reference 1 *
Name, relationship, and phone number
Your answer
Reference 2
Name, relationship, and phone number
Your answer
Signature *
By typing my full name below, I affirm that I am personally submitting this application and that the information contained is true.
Your answer
A copy of your responses will be emailed to the address you provided.
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