info@NLIGC.com
Find the applications under Programs for each session.
The application link is found at the bottom of the Program descriptions.
Name:
Organization Name:
Email:
Address:
Work Phone:
Cell Phone:
Current Job Title:
Description of Responsibilities:
Number of Years in Present Position:
Number of Employees You Directly Supervise:
Number of Years with Current Employer:
Supervisor's Name:
Supervisor's Title:
Supervisor's Address:
Supervisor's Contact Phone Number:
Supervisor's Email Address:
Why Are You Interested in ?:
What Are Your Expectations of the Program?:
What Topics Would You Like to See Included in This Leadership Program?:
How did you hear about ?:
Please complete the following demographic information.
Age: Please Select: 18 - 24 25 - 39 40 - 55 Over 55 Prefer not to answer
Race: Please Select: African American Asian White Hispanic Multi-racial Native American Pacific Islander Other Prefer not to answer
Approximate number of people your agency serves annually: Please Select: 100 or less 101-500 501-1000 1000-5000 More than 5,000 Prefer not to answer
Please confirm that you are familiar with all of the requirements of the program listed below: Payment of tuition Attendance is Mandatory for all sessions (except where excused in advance or in case of an emergency) You have full support of your employer for the required time off
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