Nevada County Community Leadership Institute
Sierra College – Nevada County Campus, County of Nevada
2019 Application
Name_______________________________________________________Date________________
Title______________________________________Employer_______________________________
Home or Work Address_____________________________________________________________
________________________________________________________________________________
Daytime Phone___________________________________Cell______________________________
Email (1)_________________________________Email (2)optional_____________________________ _________________________________________________________________________________
Tuition: $750.00 – Individual class participants are expected to personally pay at least $50.00 while their employer or sponsoring organization may pay the remainder.
Partial scholarships may be available. If you wish to request a scholarship, please indicate below
- Scholarship needed Reason_______________________________________________________
Please Initial for consideration of your application:
_____ I am able to attend the mandatory sessions on Friday, September 27th &
Saturday, September 28th from 8 am to 5 pm
______ I am able to attend at least 6 full day sessions of the 8 listed below
(Missing any portion of a session counts as a missed session)
Oct 25th Nov 22th Jan 24th Feb 28nd Mar 27nd Apr 24th May 15th June 19st
Once you have confirmed your acceptance, there is a non-refundable fee of $100.00 if you drop out before the session begins.
By signing below you agree to the following terms: You MUST attend both days of the retreat on September 27th & 28th – NO EXCEPTIONS – and you must not miss more than 2 sessions to be
eligible to graduate the program and receive your leadership certificate.
Applicant’s Signature:_________________________________________Title________________
Application due by August 2, 2019
Nevada County Community Leadership Institute c/o CNL, PO Box 1227, Nevada City, CA 95959
(530)478-9803 or [email protected]
Please complete page 2 below
Nevada County Community Leadership Institute
Sierra College – Nevada County Campus, County of Nevada
Page 2
Number of Years in Nevada County_________Length of Service with Current Employer__________
In what areas of community life do you see yourself being active in the next 10 years?
Please 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.
_____________________________has my full support for the time and personal commitment required to participate effectively in the Nevada County Community Leadership Institute.
CEO/Executive Director’s Signature___________________________________________________Title________________________
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