2017 Environmental Leadership Program Application Form
Presented by Neighborhood Housing Services of New Haven.
For descriptions of each class, visit our website: www.nhsofnewhaven.org
Name
Your answer
Date of Birth
MM
/
DD
/
YYYY
Address
Your answer
Phone Number (Home or Cell)
Your answer
Occupation
Your answer
Business/School
Your answer
How did you learn about the program?
Your answer
Please check which sessions you are able to attend. You must be able to attend at least five of the six sessions. All workshop sessions are held from 5:30pm to 8:00 pm. Dinner starts at 5:00pm. Please check all that you can attend..
Required
What motivates you to want to strengthen your environmental leadership skills?
Your answer
What skills are you most interested in gaining through the program?
Your answer
What are your dietary preferences?
Your answer
The application as well as the $20 registration fee is due by Tuesday, June 6, 2017. (Scholarships are available upon request.)
There are multiple ways to apply. You can submit this form. You can fax completed application to 203-772-2876. You can email our pdf application (on our website) to nwestfall@nhsofnewhaven.org. You can print and mail the application to NHS of New Haven at the address listed below. Space is limited. Early registration is recommended. For additional information please call Nikki Westfall at 203.562.0598 ext. 231.
Please re-type your name in the box below. In doing so, you agree that you understand the requirements required from you to attend our Environmental Leadership Program.
Your answer
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