Leadership Clark County · Program Application

PERSONAL CONTACT INFORMATION

Name

*

First Name

Last Name

Personal Email

*

This is the email LCC will use for all communication, unless otherwise requested.

Verify Email

*

Address

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Phone

*

EMPLOYER CONTACT INFORMATION

Organization/Employer

Job Title

Work Email

Verify Email

Employer's Mailing Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Business Phone

Supervisor Name

First Name

Last Name

Supervisor Email

Verify Email

PROFESSIONAL DEVELOPMENT

Please list below your most recent employment or professional development, for the last 3 years. Please include title/responsibilities and for how long you held each role. If not applicable, please skip to next section.

Upload Resume Here - Optional

Most Recent Professional Development or Employment

ORGANIZATIONS/ACTIVITIES

List the civic, business, professional, volunteer, and/or community activities in which you have participated during the past three years. Indicate for each activity the nature of your participation including any offices that you have held. List any awards or special recognition received.

Most Recent Organizations/Activities

*

INFORMATION RELEASE

*

Applications are subject to evaluation and verification based on the information provided herein. I hereby authorize my current and former employers and educational institutions to release to Leadership Clark County any information regarding my employment and/or education which may help in selecting program participants.

I acknowledge

PERSONAL STATEMENT

Your application will not be processed unless it is accompanied by a personal statement. You may either upload your statement or type it below. Please keep your statement concise, limited to 300 words, and answer only ONE of these two questions. 1) What area(s) of community involvement are you interested? 2) What achievement or activity has been the most important to you from a leadership or community perspective, and why?

Upload Personal Statement Here

Personal Statement

REFERENCES

Please provide the contact information for two community members that have known you for one year or longer.

Reference #1 Name

*

First Name

Last Name

Reference #1 Email

*

Verify Email

*

Reference #1 Phone

*

Reference #2 Name

*

First Name

Last Name

Reference #2 Email

*

Verify Email

*

Reference #2 Phone

*

ACKNOWLEDGEMENT

It is with this application that I wish to apply for the upcoming class of Leadership Clark County. I acknowledge that the information included is accurate, that an application does not guarantee enrollment, that I will be asked to participate in an interview process, and that I will be given an Offer of Enrollment before accepting participation or any financial obligations.

I accept all of the following:

*

I wish to apply for the upcoming class of Leadership Clark County

The information included in this application is accurate

This application does not guarantee enrollment

There will be a follow up interview process

I will receive an Offer of Enrollment before accepting participation or any financial obligations

TUITION OPTIONS

PLEASE SELECT A TUITION PAYMENT OPTION

TIER 1 $3,650 Provide additional financial support for those who need it in order to participate

TIER 2 $3,200 Cover the cost of the program

TIER 3 $2,750 Accept additional financial support in order to participate

TUITION ASSISTANCE/SCHOLARSHIPS/PAYMENT PLANS

THIS SECTION IS OPTIONAL - IN THIS SECTION YOU ARE ABLE TO APPLY FOR TUITION ASSISTANCE/SCHOLARSHIPS AND REQUEST INFORMATION ABOUT SETTING UP A PAYMENT PLAN FOR TUITION. THIS SECTION IS OPTIONAL.

Scholarships

Leadership Clark County (LCC) offers two different scholarships to assist individuals with the tuition of the LCC program. In order to be considered for a scholarship award, candidates must meet all regular requirements for acceptance into the program by completing the program application and completing the scholarship application. Applicants can apply for one or both scholarships. It is important to note that LCC does not typically award full tuition scholarships and the total amount of most scholarship awards range from 20% to 50%. To request a scholarship, please provide a one-page statement with the information listed below for each scholarship for which you are applying.

Leadership in Diversity, Equity, and Inclusion

This scholarship exists to encourage and develop future leaders who are passionate about and contributing to the advancement of diversity, equity, inclusion, and the elimination of racism. You may either upload your statement on a separate document or type it in the field below.

I'd like to apply for this scholarship

Please include a one page statement providing insight into the steps you have taken to advance diversity, equity, and inclusion personally, professionally, and/or for the community. In your response please share any plans you have for continuing to advance this work in the future.

Please include the following information in your statement; Amount of Scholarship you are requesting, Amount you will personally contribute towards tuition, Amount your employer or another sponsor is contributing towards tuition.

Upload DEI Scholarship Statement Here

DEI Scholarship Statement

Financial Assistance

Tuition assistance will be based upon the demonstration of financial need which otherwise would prevent participation in the Leadership Clark County Program. You may either upload your statement on a separate document or type it in the field below.

I'd like to apply for financial assistance

Please include a one page statement providing insight into your request for tuition assistance based on financial need.

Please include the following information in your statement; Amount of Scholarship you are requesting, Amount you will personally contribute towards tuition, Amount your employer or another sponsor is contributing towards tuition.

Upload Financial Assistance Scholarship Statement Here

Financial Assistance Scholarship Statement

I acknowledge all of the following:

Program acceptance does not guarantee a scholarship will be awarded

Any scholarships awarded will be calculated on Tier 2 tuition ($3200) and will subject to a scholarship agreement

PAYMENT PLAN

PAYMENT PLANS ARE AVAILABLE TO ASSIST WITH PAYING TUITION

I would like to receive information about setting up a payment plan for my tuition.