2027 R. David Tebben Community Leadership Academy
29th Annual | January -April 2027 (Final dates TBD)
Full Name:
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First Name
Last Name
Home Address:
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Street Address
Street Address Line 2
City
State
Zip Code
Phone Number:
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Please enter a valid phone number.
Format: (000) 000-0000.
Email Address:
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example@example.com
Employer / Company:
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Position / Title:
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Immediate Supervisor's Name and Title:
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Immediate Supervisor's Phone Number:
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Please enter a valid phone number.
Format: (000) 000-0000.
Immediate Supervisor's Email Address:
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example@example.com
Please provide email for the tuition invoice. Invoices will be sent in January 2027 and must be paid prior to the first day of class.
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tuition@example.com
Briefly describe your work responsibilities:
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Briefly explain your interest in attending the R. David Tebben Community Leadership Academy and your expectations of the program:
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