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Application: LSC Signature Program, 2023-2024
About the Application Process
In identifying quality candidates, we review each application carefully, looking for community involvement and leadership potential. You must complete and e-sign your application and your sponsor/employer (if applicable) must complete an agreement as well. Tuition is $3,500. The nonprofit rate is $3,100. Limited scholarship support is available. For more information about Leadership Snohomish County or the Signature Program, please contact us at lscprograms@leadershipsc.org or call 425.521.7293. To be considered for the Fall 2023 Signature Program, applications must be submitted by September 18, 2023.
Contact Information
Name
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First Name
Last Name
Preferred Phone
Preferred Email
Verify Email
Personal Address
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Demographic Information
How do you identify your race/ethnicity?
African American/Black
African
Asian American
Pacific Islander
Hispanic/Latinx
Native American
Middle Eastern
European American/White
Multi-racial
Prefer not to answer
Other
Gender Identity
How do you identify your gender? (Select one or more)
Woman
Man
Agender
Gender Non-Conforming
Gender Fluid
Pangender
Non-Binary
Unsure or Questioning
Trans Man
Trans Woman
Prefer not to disclose
Other
Preferred pronouns
Please list your preferred pronouns
LSC Alumni Status
Have you completed any other LSC Program?
Young Professional
Leadership for Racial Equity
Not an LSC Alumni
Work/Employer Information
Organization/Employer
How long have you been employed with this organization?
Your Position/Title
Supervisor's Name and Title
CEO or Executive Director Name
Business Address
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Would you like to be considered for scholarship support?
Please be mindful that scholarships are limited and LSC cannot guarantee scholarships.
No, I will not be requesting financial support
Yes, for the Deborah Knutson Women in Leadership Scholarship
Yes, for the Leaders of Color scholarship
Yes, for the LSC Tuition Support Fund
Yes, for the Refugee / Immigrant Scholarship
Yes, for the Second Chance scholarship
Tell us about your Experience
Describe your involvement in current or past civic or community activities.
For instance, include organization memberships, honors, or achievements.
Describe any additional history you’d like to share relative to leadership, mentoring, or other professional experience.
What do you hope to gain from your Leadership Snohomish County experience?
Commitment Agreement
In order to be considered for the program, you must commit to all of the following. If you have any known conflicts with the dates and/or scope of commitment, please contact Nelia Viloria at neliav@leadershipsc.org before submitting your application.
I agree to:
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Participate in a two-day retreat on September 21 and 22, 2023 from 8:30 a.m. – 4 p.m and a short evening reception following the retreat on the 21st.
Attend monthly Education Days starting in October. I understand I must fully participate in the seven Education Days (8:00 a.m. to 5 p.m.) and a Project Presentation day.
Participate in a community impact project with a project team. I understand these projects are part of the leadership development program and are in addition to the Education Days.
I understand that as a part of exploring civic issues, the LSC program includes learning about race, racism, and racial equity in a group setting and I am willing to engage in this work.
By submitting this application, I confirm that I understand the requirements of the Signature Program and agree to fully participate in the program, if selected.
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First Name
Last Name
