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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
City
State
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
City
State
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. Or upload your most recent resume. Please include title/responsibilities and for how long you held each role. If not applicable, please skip to next section.
Upload Resume Here
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 $3,500 Provide additional financial support for those who need it in order to participate
TIER 2 $3,050 Cover the cost of the program
TIER 3 $2,600 Accept additional financial support in order to participate
TUITION ASSISTANCE/SCHOLARSHIPS/PAYMENT PLANS
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.
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.
I'd like to apply for this scholarship
Scholarship Amount Requested
LCC does not typically award full tuition scholarships. Most scholarship awards range from 20% to 50%.
Financial Assistance
Tuition assistance will be based upon the demonstration of financial need which otherwise would prevent participation in the Leadership Clark County Program.
I'd like to apply for financial assistance
Amount of Financial Assistance Requested
LCC does not typically award full tuition assistance. Most assistance awarded ranges from 20% to 50%.
What amount are you able to personally contribute toward tuition, if any?
What amount is your employer/other able to contribute toward tuition, if any? Copy
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 and will subject to a scholarship agreement
Please upload any statements, documents, or resources that you feel may be helpful in evaluating your scholarship or tuition assistance request.
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.