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Fall 2021 Sweet Home Rural Community Youth Leadership Program Application

Sweet Home, OR 2021

The Leadership Training is made possible by the City of Sweet Home, and is administered and delivered by local trainers in conjunction with Rural Development Initiatives. We hope that your interest and involvement will benefit you and the communities that you serve and live in.
All starred fields are required. If a required field does not apply to you, please enter "N/A" (the form will not submit with empty required fields).
All sessions are in-person and include either Lunch or Dinner.

Session 1 – Thurs. 11/11/21, 9:00 am – 3:30 pm (Veterans Day Holiday)
Session 2 – Wed. 11/17/21, 2:30 – 6:00 pm
Session 3 – Wed. 12/1/21, 2:30 – 6:00 pm
Session 4 – Wed. 12/8/21, 2:30 – 6:00 pm
Session 5 – Wed. 12/15/21, 2:30 – 6:00 pm
Session 6 – Wed. 1/5/22, 2:30 – 6:00 pm
Session 7 – Mon. 1/17/22, 10:00 am – 2:00 pm (MLK Holiday)
Session 8 – Mon. 2/21/22, 10:00 am – 2:00 pm (Presidents Day Holiday)
Session 9/Graduation –  Wed. 3/16/22, 4:00 – 8:30 pm

Questions?
Contact Jessie Katon
Program Coordinator: 458-215-8396 x7005 | jkaton@rdiinc.org
rdiinc.org/rural-community-leadership-program/
1.Parent's Information(Required.)
The following questions are for the Participant/Youth.
2.Participant (Youth's) Information(Required.)
3.Preferred method of contact
Email
Home Phone
Cell Phone
4.Gender(Required.)
5.Age(Required.)
6.Date of Birth
(Required.)
7.Level of Education(Required.)
8.
Service: Group, Coalition, Network, Organization or other
Provide information for organizations or groups in which the participant is 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"
9.Nominator's Name -- If applicable, please provide the name of the person who nominated the participant to apply.
10.Length of time in your community?
Provide the time in years(Required.)
11.What do you hope to gain from participating in RDI's Leadership Program?(Required.)
12.Describe the current issues and opportunities that you see in your community to make it a better place to live or work in.(Required.)
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.
13.Previous Leadership Training(Required.)
14.Name of Leadership Program
15.Sponsoring Agency or Program
16.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.
17.Dietary Restrictions?(Required.)
18.Allergies?
List your food allergies.
19.Will you need special assistance or accommodations?
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 for Rural Development Initiatives and partnering organizations 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 and partnering organizations shall select all participants and may terminate my participation at any time, at their sole discretion. By participating in this program I agree to be a part of the Rural Action Network.