Lead Local Application

Question Title

* 1. First and Last Name

Name

Question Title

* 2. Personal Contact Information

Email Address

Phone Number

Question Title

* 3. Nonprofit Organization

Organization Name

Address

City

State

ZIP

Question Title

* 4. What is your role with the nonprofit organization?

Question Title

* 5. What is your nonprofit's annual operating budget?

Question Title

* 6. What would being a part of this program mean to you?

Question Title

* 7. Where did you hear about this opportunity?

Question Title

* 8. Who will be your partner for this course?

Question Title

* 9. The Dare to Lead™ program requires courage, vulnerability, and active participation. When applying for Lead Local, you are making a commitment to yourself and others to engage in all aspects of the program. By checking the box below, you formally recognize and commit to attending all sessions, virtual check-ins, and being an active participant in the program.

I acknowledge and accept