LAHC Civic Leadership Program Registration Form

An 8-Week interactive program for college students & aspiring public administrators to navigate government systems, influence policy, and lead with civility through expert-led sessions, advocacy training, and exclusive networking opportunities.

Held Tuesday Evenings every week from 5:15 PM to 7:15 PM

Starting on Tuesday, June 2nd and going through to Tuesday, August 4th

At LAHC: 5275 Kenilworth St., Dearborn, MI 48126

Please feel free to share this with friends, colleagues, or family members who may be interested in joining.

Name

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

City and/or County of Residence

Gender

Race/Ethnicity

Current Role/Position (Student, Professional, Community Leader, etc.)

Organization/Academic Institution (if applicable)

Highest Level of Education Completed

Age Range

Why are you interested in this program?

What specific skills or knowledge do you hope to gain?

How did you hear about this program? (Please choose all that apply.)

Would you like to receive updates on future leadership programs?