Leadership Program

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Bridging Brown County Leadership Program Application

Tuition fees for 2021-2022 is $400 for nine leadership days.

This includes all meals, refreshments, training and transportation.

Applications are due by June 30, 2021. The first session will be held on Thursday, September 23, 2021.

Our next cohort will begin September 2021.

1 Start 2 Complete

First Name *

Last Name *

Home Address *

City, State, Zip Code *

Mobile Number *

Work Number *

Personal Email *

Work Email Address *

Years living/working in Brown County *

The answers to the questions in this section are optional.

Age

Ethnic Background

Gender

Community Involvement

Please describe present or past involvement in community or county organizations, activities, and volunteer work:

Please include organization and position held/responsibilities. *

Occupation

Employment Status: *

Place of Employment *

Employer Address *

Do you need scholarship assistance to participate? *

Yes

City, State, Zip Code

My employer is willing to make available the necessary time for full participation in all scheduled sessions.

Yes

Other work experience/training

Why do you want to participate and what do you hope to gain from participating in the Bridging Brown County Leadership Program? *

I understand the purpose of the Bridging Brown County Leadership Program, the requirement to attend the scheduled sessions, and that the completion of this application does not guarantee my acceptance as a participant. If selected to participate, I will devote the time required.

Signature *

Date *

Month

Day

Year

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Bridging Brown County Leadership Program Application

Community Involvement

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