Henderson Leadership Initiative Class Application
Please complete the form below and click SUBMIT. If you should have any questions, contact HendersonLeadershipInitiative@gmail.com.
Full Name
*
First Name
Last Name
E-mail
*
example@example.com
Phone Number
*
Format: (000) 000-0000.
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Place of Employment
*
Job Title
*
Employment Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Education: Include Institution Name, Field of Study, Dates Attended, and Degree Earned.
*
Employment History: List the three (3) most recent, with the most recent first.
*
Leadership Roles: List, in order of importance to you, no more than three (3) of your most significant leadership roles.
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Community Involvement: Describe your involvement with community groups- please include name of group, nature and length of time for your involvement.
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What is the most satisfying contribution to your community?
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What does LEADERSHIP mean to you?
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What are your professional and civic involvement goals for the next 10 years?
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If you could change or improve one thing about your community, what would it be?
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Why are you seeking acceptance into HLI?
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Name your greatest leadership strength AND your greatest leadership weakness.
*
Agreement & Signature: Your commitment as an applicant to the program is required for the application to be processed. Please sign below to verify your desire to participate in the HLI program. This commitment also confirms your agreement to make every effort to attend and participate fully in all sessions of the HLI program.
*
Scholarship Request: If you are in need of tuition assistance, please provide rationale below as to why you would like to be considered for a scholarship, what amount you could reasonably manage and if you would be interested in a payment plan.
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