LAHC Civic Leadership Program Registration Form

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.

Tuesdays April 7th - June 9th: 6:00 PM - 8:00 PM

At LAHC: 5275 Kenilworth St., Dearborn, MI 48126
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*
FemaleMalePrefer not to say
WhiteBlack or African AmericanMiddle Eastern or Arab AmericanAsianAmerican Indian or Alaska NativeHispanicNative Hawaiian or Other Pacific IslanderMultiracialPrefer not to sayOther
Current Role/Position (Student, Professional, Community Leader, etc.)*
Organization/Academic Institution (if applicable)*
Highest Level of Education Completed*
18-24 years old25-34 years old35-44 years old45-54 years old55+ years old
Why are you interested in this program?*
What specific skills or knowledge do you hope to gain?*
Social MediaWebsiteReferralFlyerLAHC StaffOther
YesNo
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