Mastering Inclusive Leadership -- Financial Aid Scholarship Application
Applications must be received by 11/23/21

Program Dates December, 1-2, 2021

1440 Leadership Center is pleased to provide scholarships for those who qualify.

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* 1. GENERAL INFORMATION

Name

Email

Phone

Street Address

City and State

Zip Code

Employer

Role/Title

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* 2. Have you taken part in any programs or activities that reflect your commitment to your leadership development? Please list.

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* 3. Is your employer contributing funds for you to attend this program?

Yes

No

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* 4. Tell us about your financial need.

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* 5. Which racial categories do you use to identify yourself? response not required

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* 6. What is your approximate average household income?

$0-$24,999

$25,000-$49,999

$50,000-$74,999

$75,000-$99,999

$100,000-$124,999

$125,000-$149,999

$150,000-$174,999

$175,000-$199,999

$200,000 and up

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* 7. How will you share what you learn with others and your organization?