Leadership Susquehanna Valley
LSV 2015.jpg

Application

Application

 

LSV Application

Name *
Name
Address *
Address
Date of Birth *
Date of Birth
Cell Phone *
Cell Phone
Home Phone
Home Phone
Employment Information
Employer Contact Name
Employer Contact Name
Employment Start Date
Employment Start Date
Employer Address
Employer Address
Employer Phone
Employer Phone
References
Reference #1 Name *
Reference #1 Name
Reference #1 Address
Reference #1 Address
Reference #1 Phone *
Reference #1 Phone
Reference #2 Name *
Reference #2 Name
Reference #2 Address
Reference #2 Address
Reference #2 Phone *
Reference #2 Phone
Previous Employment (Including Military Duty)
Start Date (1)
Start Date (1)
End Date (1)
End Date (1)
Start Date (2)
Start Date (2)
End Date (2)
End Date (2)
Please answer the following questions with a typed response
Employment
Community or State Involvement
General
Education
Personal Commitment
The Leadership program will begin with a day and a half retreat (overnight stay is required), followed by eight monthly day-long sessions, community tours, group projects and other practical experiences. This program will require a significant amount of time - one full business day out of the office each month - some local travel and additional out-of-class preparation and assignments. Day-long sessions are scheduled for the 3rd Thursday of each month. Attendance at EACH Program Day is required.
I understand that I am expected to attend ALL Program Days. *
Check all that apply *
Sponsor Commitment
As Applicant’s sponsor I agree to the following (check all that apply)
Sponsor Name
Sponsor Name

Tuition Fee

$1,500.00
 

Program Topics

  • Education

  • Communications/Public Relations

  • Health & Human Services

  • Economic & Workforce Development

  • Local Government

  • Law & Judiciary

  • Agriculture/Natural Resources

  • Tourism/Recreation


Deadline

June 14, 2019 | All completed applications due to Leadership Susquehanna Valley.
June 28, 2019 |  Selections Committee will notify candidate of application status.
July 19, 2019 Final payment due for accepted LSV program participants.
 

All expenses, including speakers, room rental, equipment fees and meals are included in the tuition fee.
Participants are responsible for their own travel expenses.