Leadership Brevard Class of 2024 Enrollment Form

-LEADERSHIP BREVARD PROGRAM GOALS-

Provide you with community education.
Build relationships with your classmates.
Connect you to a network of community leaders.

My expectations for the Leadership Brevard Class of 2024 experience are:

1.*

2.*

3.*

How will you contribute to the diversity of the Leadership Brevard program? *

How did you learn about the Leadership Brevard program*

- 2024 PROGRAM TUITION -

Fall Cohort: August 2023 – April 2024

Spring Cohort: January 2024 - September 2024

Tuition for Leadership Brevard: $3,500

A minimum deposit of $500 is due upon enrollment in order to reserve your seat in Leadership Brevard 2024. The remaining tuition balance must be received in full by July 15th, 2023 for the Fall Cohort and December 15, 2023 for the Spring Cohort, unless other arrangements have been made with LEAD Brevard.

Limited scholarships are available based on demonstrated need and availability of funds. If you elect to apply for Financial Assistance below, please note that each scholarship recipient will be required to contribute a minimum of $500 towards their Leadership Brevard Tuition. The Financial Assistance Request Form will be sent to you separately and must be completed by June 15, 2023 for the Fall Cohort and November 15, 2023 for the Spring Cohort.

A payment plan option is available. The amount covered by the payment plan is equal to the total tuition (less any financial assistance awarded, if applicable). A $500.00 deposit is required with the enrollment form to reserve your seat regardless of the payment plan structure for the balance. The first payment of the payment plan is due prior to the first session, Fall Cohort - August 15, 2023 | Spring Cohort - January 16, 2024; subsequent payments are due on the 15th of each month following. The balance total must be paid in full by Fall Cohort - December 15, 2023 | Spring Cohort - May 15, 2024 in order to be considered a candidate for graduation. Payments may be made by check or credit card.

Cancellation for the Fall Cohort: Cancellation must be received on or before July 15th, 2023 prior to the start of the program year for a full refund. After July 15th, a $500 cancellation fee will be charged. After the first of August, a 50% tuition cancellation fee will be applied ($1750). Tuition is NOT refundable in whole or in part after August 15th, 2023.

Cancellation for the Spring Cohort: Cancellation must be received on or before December 15th, 2023 prior to the start of the program year for a full refund. After December 15th, a $500 cancellation fee will be charged. After the first of January 2024, a 50% tuition cancellation fee will be applied ($1750). Tuition is NOT refundable in whole or in part after January 16th, 2024.

Payment Information*

I would like to make my $500 deposit via CC online, and will make arrangements with LEAD Brevard for my remaining balance by deadline.I would like to make my $500 deposit via check by sending it to: LEAD Brevard 123 Barton Blvd, Suite101, Rockledge, FL 32955 Check payable to: LEAD Brevard; and will make arrangements with LEAD Brevard for my remaining balance by deadline.I would like to make my $3500 Tuition payment via CC online.I would like to make my $3500 Tuition payment via check by sending it to: LEAD Brevard 123 Barton Blvd, Suite101, Rockledge, FL 32955 Check payable to: LEAD Brevard

Additional Payment Information*

I am applying for a Leadership Brevard ScholarshipI am requesting a payment planI am requesting both a Leadership Brevard Scholarship & Payment Plan (for the remaining balance if applicable)I am not requesting either option

Payment Information - Once the form is submitted LEAD Brevard will reach out to you via email with your next steps.

STATEMENT OF COMMITMENT:

I First Name* Last Name* understand the Leadership Brevard program goals. I will devote the time necessary to complete the program. This includes attendance at the day-long Opening Session, day-long program sessions, and the evening Graduation Ceremony; as well as participation in the Community Acceleration Project(s) (CAP) and CAP Presentation evening. If I am unable to comply with the requirements, I will voluntarily withdraw from the program. I understand that, in the interest of the class experience for all participants, any participant may be removed from the class if, in the opinion of LEAD Brevard, that participant’s conduct is not conducive to the work of the group or there is a failure to meet participation requirements. I understand that there is a Leadership Brevard mobile app and will be respectful of the program presenters and my peers when accessing my mobile device for program-related purposes. I further understand that tuition is NOT refundable in whole or in part after your specific cohorts deadline;

Fall Cohort: August 15, 2023
Spring Cohort: January 16, 2024

Signature* Date*

ENROLLMENT AGREEMENT ATTENDANCE REQUIREMENT: If emergency/circumstances arise that prevent a participant from attending all or any portion of ONE SESSION, the participant may be excused from attending all or a portion of one session. If for any reason a class member misses TWO SESSIONS, he/she will be removed from the program and will not be eligible to graduate that year. This will be strictly enforced going forward.*

Please enter your name indicating you understand and agree to follow this policy.

Enrollment is not considered complete until the enrollment is submitted and you have received confirmation from Mary Tabeling, Administrative Coordinator (Mary@LEADBrevard.org)

If you submit your application and do not receive a reply within 48 hours (2 business days), please reach out to Mary Tabeling or Candice Barton, Coordinator, Leadership Programs by email: Candice@LEADBrevard.org or call 321-632-8222

SAVE YOUR ENROLLMENT FORM & PRINT BEFORE SUBMITTING!

Enrollment Form - Leadeship Brevard Class of 2024