Leadership America Application

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Application Questions
Did someone encourage you to apply for Leadership Women America?*

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Who encouraged you to apply?

First Name Last Name
Please provide a professional biographical summary that will be printed in the official Leadership America Directory if you are chosen for the class. *

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If accepted, who will pay the tuition costs?*
Please explain the reason for your request for a partial scholarship.
You may be contacted for additional information concerning your tuition request.
Please submit a 5"x 7" headshot-style photograph.

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I certify that all of the statements made in this application are true, complete, and correct to the best of my knowledge and are made in good faith. I know and understand that all items may be verified. If selected, I have company/organization support for my participation, where applicable, and I will be able to attend both sessions in their entirety. Also, if selected, I will remit to Leadership Women the tuition fee of $3,800. I understand the tuition is nonrefundable and that my space may be forfeited if tuition is not received by the deadline.
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Application Fee*

Leadership America App Fee$65.00

Total $0.00

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Submitting this form constitutes acceptance of the terms and conditions found in the application above.
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