NCCLI Application - Community Foundation of Nevada County

Name(Required)

First Last

Preferred Name for Name Tag

Employer

Cell Phone(Required)

Title(Required)

Other Phone (optional)

Email (work)(Required)

Email (2)

Tuition: $1150.00

Partial scholarships may be available. We have a limited number of scholarships available at $250 and $500. 2. Have you requested support from your employer, agency, organization, or another sponsor? 3. Please briefly describe why scholarship support is needed and how participation in NCCLI will strengthen your community leadership.

If you wish to request a scholarship, please check here.

Please indicate which tier you are interested in.

$250

$500

Have you requested support from your employer, agency, organization, or another sponsor?

Yes, I have requested support.

No, I have not requested support.

Please briefly describe why scholarship support is needed and how participation in NCCLI will strengthen your community leadership. If you are not requesting as scholarship, type N/A.(Required)

Please check for consideration of your application

I am able to attend the mandatory sessions from 8:00 to 5:00 pm on Friday, September 25th and Saturday September 26th.

I am able to attend at least 6 full day sessions out of 8 listed below (Missing any portion of a session counts as a missed session)

Session Dates

October 23

November 20

January 22

February 26

March 26

April 23

May 21

June 25

Signature(Required)

By signing below I agree to the following terms: Attending the first sessions Friday, September 26th , & Saturday, September 27th and attending an additional six (full-day sessions) to be eligible to graduate the program and receive the leadership certificate.

Number of years in Nevada County(Required)

Length of service with current employer(Required)

In what areas of community life do you see yourself active in the future?(Required)

Briefly describe your current civic activities, including memberships, volunteer activities and any leadership position already held.

Sponsor's Agreement

Applications for the Nevada County Community Leadership Institute must have the support and commitment of their sponsoring business or organization. The CEO/Executive Director’s signature of their sponsoring organization is required as an indication of the support for the nominee’s participation in the program. A sponsor’s agreement is not necessary for self-employed or retired applicants.

By typing my name below, I agree that the applicant has my full support for the time and personal commitment required to participate effectively in the Nevada County Community Leadership Institute.(Required)