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LGBT Leadership Institute Application

SECTION A: BASIC INFORMATION

Salutation

Please provide your Legal First Name. You may enter your Preferred First Name in the Preferred Name field below.

First

Mid. Initial

Last

Suffix

Preferred Name (if different)

Pronouns

He - Him - His

She - Her - Her

Zie - Zim - Hir

They - Them - Their

Mobile Phone

Office Phone

Email Address

Street

City

State

Zip Code

Employer Information

Job Title

Employer

Employer Contact/Manager

Employer Phone

Employer Email

Employer Address

Employer City

Employer State

Employer Zip Code

Have you previously applied to the LGBT Leadership Institute?

YesNo

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LGBT Leadership Institute Application

LGBT

SECTION B: DISCUSSION ITEMS

The following discussion questions are a critical part of your application. Please answer each of them fully to the best of your ability.

1. What are your job responsibilities?

(limit to approx. 500 words)

2. How do you define leadership?

(limit to approx. 500 words)

3. Provide an example of your leadership experience.

(limit to approx. 500 words)

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LGBT Leadership Institute Application

LGBT

SECTION C: RECOMMENDATIONS

Please attach two letters of recommendation. If possible, one letter should be from your employer or immediate supervisor/manager.

Letter of Recommendation #1

Name & Title of Recommender

Email

Phone

Letter of Recommendation #1

Letter of Recommendation #2

Name & Title of Recommender

Email

Phone

Letter of Recommendation #2

LGBT Leadership Institute Application

LGBT

SECTION D: PAYMENT

Tuition for this program is $1,500. Tuition must be paid prior to orientation session.

Employer Commitment

My employer fully supports my participation in the LGBT Leadership Institute and understands the time commitment required.My employer does not support my participation in the LGBT Leadership Institute.

My LGBT Leadership Institute tuition will be paid by:

Company
Organization
Applicant
Other

Enter the name and email address of the person responsible for paying tuition.

Name

Email

Scholarship Information

A select number of full and partial scholarships are available. Scholarships are awarded solely on the basis of documented financial need and availability of scholarship dollars. Proof of financial need may be requested.

Do you wish to apply for a scholarship?

YesNo

Scholarship amount requested: $

If you are requesting a scholarship, please explain the circumstances.

It is my understanding that LGBT LEADERSHIP INSTITUTE is a learning experience and requires attendance at its monthly meetings. The Orientation session, which is mandatory, will be held in August, 2021, with subsequent meetings on the second Friday of each month beginning on September 10, 2021 and continuing through May 13, 2022. Any participant missing any part of either Orientation or more than two sessions (or equivalent hours) will not graduate.

The size and make up of each LGBT LEADERSHIP INSTITUTE CLASS is carefully considered to ensure that it is broad based, representing a variety of professional, economic, social, and ethnic backgrounds. This means that many highly qualified applicants cannot be accepted the first year they apply. We encourage you to re-apply should you not be accepted this year.

I hereby give LGBT Leadership Institute/LGBT Chamber of Commerce Foundation the right to make inquiries regarding the information provided on this application.

NOTE: When you have completed this application click on the "Go to eSignature" button. This will refresh the screen so you may review your application before signing. Once the screen refreshes, scroll down to review the application.

Contact Id

Employer or Resource Group	Event	Friend or Colleague
Newspaper	Online Site	Organization
Chamber Communication	Word of Mouth	Other

Female	Gender Queer
Trans Female	Trans Male
Intersex	Other
Male

American Indian or Alaska Native	Asian
Black or African American	Native Hawaiian or Other Pacific Islander
White	Some Other Race

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