Greater Palouse 2018

The Leadership Training is made possible by Inland Northwest Community Foundation, Empire Health Foundation, Avista Foundation, and community sponsors, and is administered and implemented by Rural Development Initiatives. We hope that your interest and involvement will benefit the communities that you serve and live in. 

Notice of Participation: Rural Development Initiatives will inform you of your acceptance into the program by Mid-January of 2018. Classes will begin in February of 2018.

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* 1. Candidate Information

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* 2. Preferred method of contact

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* 3. Gender

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* 4. Date of Birth

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Nominator and Community Information (If applicable)

If applicable, please provide the name of the person who nominated you to apply. In an effort to know more about the community you live in or work in we ask that you provide community information.

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* 5. Nominator's Name

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* 6. Length of time in your community?
Provide the time in years

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* 7. What is your role in the community? (Check all that apply)

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* 8. What do you hope to gain from participating in RDI's Leadership Program?

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* 9. Describe the current issues and opportunities that you see in your community to make it a better place to live or work.

Work, Education, and Service

Provide information on your place of employment and community service.

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* 10. Employment Information

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* 11. May we contact you at work?

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* 12. Are you elected or appointed to public office?
County Commissioner, Mayor, Council Member, City Manager, City Clerk, etc.

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* 13. Level of Education

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* 14. Service: Group, Coalition, Network, Organization or Other
Provide information for organizations or groups in which you are a current member or actively volunteer on a regular basis.
Examples: civic, youth, service, education, faith groups. Commissions and task forces, military reserves, elected office.
Area of service: local, community, regional, state, national or international.
If none, write "None"

Leadership and Personal Interests
Provide information on previous leadership training and expand on your personal interests so that we can get to know you better.

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* 15. Previous Leadership Training

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* 16. Name of Leadership Program

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* 17. Sponsoring Agency or Program

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* 18. Your Personal Interests
List things related to your hobbies, activities, family life, we will include some of this information in the class directory.

Logistics
We will provide catering services and will do our best to work to accommodate allergies and special diets if your request cannot be accommodated, we will inform you so that you can consider bringing your own meals and snacks.

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* 19. Dietary Restrictions?

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* 20. Allergies?
List your food allergies.

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* 21. Will you need special assistance or accommodations?

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* 22. Child Care Services
We will make an effort to ensure that child care services are not a barrier to your attendance of the Leadership Training. Will you need help with child care services?

Certification and Submission of Application
I hereby certify that the information contained on this application is truthful and I give my consent to Rural Development Initiatives to verify any and all information contained on the application. I understand that with this application I am accepting a commitment to attend all meetings with the exception of emergencies. I understand that my contact information, affiliations and personal interests will be shared in a class directory and that my contact information may also be shared with partner organizations when relevant to the interests in promoting rural community vitality. I understand that information in this application will be used in program evaluation efforts, but that my name or other identifying information will not be shared in any reports. I give permission to Rural Development Initiatives to use my name in press releases, photograph or videotape me for class related purposes, as well as post my photo or video on program-related websites (in small or large groups). I understand that my participation in this program is voluntary and that representatives of Rural Development Initiatives shall select all participants and may terminate my participation at any time, at their sole discretion.

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