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 27^th  &
Saturday, September 28^th  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  25^th          Nov  22^th           Jan  24^th          Feb  28^nd           Mar 27^nd          Apr 24^th        May 15^th         June 19^st  
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 27^th & 28^th – 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________________________

Page 2 of 2