Leadership Medina County

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2024 LEAD Institute Application
Leadership Medina County’s LEAD Institute program is designed for those looking for professional development training and to further develop their leadership skills. See webpage for a full program description at https://leadershipmedinacounty.org/lead/. Generally the program runs from September – May on the 3rd Thursday* of each month from 9:00 a.m. to 5:00 p.m. and includes lunch. Class size is limited to 35 individuals. Tuition is $3,000 and includes all materials, texts, and assessments. Certificates will be issued to each participant upon completion of the program. Participants in Leadership Medina County’s LEAD Institute program will be selected from those individuals who have submitted their applications by the deadline. Please note: Invoices for the $3,000 non-refundable tuition will be issued with notification of acceptance. DO NOT send payment with application. Participation In order to accomplish the program’s stated objectives, attendance and full participation of each individual selected is necessary. Participants must be able to commit to the full class schedule below and class project. However, we realize that “life happens” sometimes. Therefore, we do allow for ONE excused absence per class year. More than one absence could disqualify a program participant from graduating from the program. Opening Retreat is mandatory. Timeline March 1: Apply online June 4: Application deadline July 1: Class is selected, and applicants are notified August: Tuition assistance is granted August 25: Tuition Due September 9: Class is formally announced Click here for the Class Calendar This program includes a class project. The project will be assigned during the opening retreat.
Application
Please note, this application may time out after 40 minutes of inactivty. We suggest saving your work reguarly.
First Name *
Last Name *
Personal Pronouns
Name as it should appear on name badge *
Name as it should appear on certificate *
Preferred Name *
Business Information
Company Name *
Title *
Business Email *
Business Phone *
Business Address 1 *
Business Address 2
Business City *
Business State/Province *
Business Zip *
Supervisor's Name *
(If you do not have a supervisor, please write n/a. We will send an employer agreement form to you.)
Supervisor's Title *
Supervisor's Email *
Personal Information
Cell phone *
Personal Email *
Home Address (Line 1) *
Home Address (Line 2)
Home City *
Home State *
Home Zip Code *
Part of the class experience includes working on your LinkedIn profile. Do you have a LinkedIn profile? If so, share the link. If you don't have a profile, please write no. *
Education
Name and City of High School *
High School Graduation Year *
Name and City of College
College Graduation Year/Degree and Major
Name and City of College (2)
College Graduation Year/Degree and Major (2)
Military Service
Please include what branch of the military.
Interests
Select from the following interests. You may select more than one.
Interests *	Advocacy Agriculture Aging/Senior Services Animals Arts Children/Youth Civil rights Conservation/Environment Disabilities Economic Development Education Energy Event Planning Family Finance Foundations Government/Public Service Grant Writing Health History Housing Human Services/Social Services Law/Criminal Justice/Safety Literacy Mental Health Mentoring Media/Communications Policy Poverty Recreation/Sports Religion/Religious Organizations Strategic Planning Substance Abuse Technology Workforce Development Young Professionals Other
How did you learn about Leadership Medina County? *
Tuition
Tuition is $3,000 per participant.
How will your tuition be paid? Select all that apply *	Employer Self I am requesting Tuition Assistance
If you requested tuition assistance, please provide the reason for requesting assistance and the amount requested.
Refund Policy Click here to read the refund policy.
I have read and understand the refund policy. *	Yes
Time Commitment
Are you able to fully commit to the noted class days? *
Do you have full support from your employer/family for the time required to participate effectively in this program? *
Commitment
I understand the purpose of this program and that completion of this application does not ensure a candidate’s acceptance into the class. If selected, I will devote the time required to fulfill all obligations to the program and Policies and Commitments. By entering my name in the box, I am approving this as an authorized signature for my application.
Type your name to agree *
Thank you for completing part one of your application! Upon submission, you will received an email from terri@leadershipmedinacounty.org to complete Part #2 of the application which will be due within one week of submission of Part 1. Applicants will be notified of their acceptance on or around July 1. Non-refundable payment is due by August 25

Timeout Warning

2024 LEAD Institute Application

Application

Business Information

Personal Information

Education

Interests

Tuition

Time Commitment

Commitment