Community Leadership Series Application

Be Prepared

Thank you for your interest in applying for the Community Leadership Series. We are currently accepting applications for the Class of 2025. Please read the instructions prior to completing the online application form. The application form and all attachments must be submitted by Friday, June 7, 2024 in order to be considered.

INSTRUCTIONS

Read EXPECTATIONS and agree to the terms.
Complete APPLICANT INFORMATION section.
Respond to the ESSAY questions and upload your file.
Review PAYMENT INFORMATION and agree to the terms.
In the EMPLOYER/SPONSOR RESPONSIBILITY section, please download the form, secure the required signatures, and then upload the signed form.
IF APPLICABLE, complete the SCHOLARSHIP section.

Please complete the application form for the Community Leadership Series by Friday, June 7, 2024.

2024-2025 CLS Schedule

Opening Retreat: September 5 & 6, 2024

Session Dates:
2024 – October 2, November 6, December 4
2025- January 8, February 5, March 5, April 2, May 7

Graduation: May 2025 (Date TBD)

Expectations

TUITION
Tuition for the Community Leadership Series is $3,500. No payment is required at the time of application.

ATTENDANCE
The Community Leadership Series includes approximately 100 hours of session time. To graduate from the Community Leadership Series, a participant is expected to attend all sessions. CLS includes a two-day, overnight retreat each September, and full-day sessions are generally held on the first Wednesday of the month from October through May. Attendance at the two-day retreat is mandatory. Attendance at each of the monthly sessions is required. Two excused absences (or a total of 17 session hours) will be permitted during the series (not including the Opening Retreat). Participants who miss more than 17 session hours or two monthly sessions, for any reason, will not be permitted to graduate. The tuition will not be refunded.

TEAM PROJECTS
An experiential service project for a local non-profit organization is part of the Community Leadership Series. Each participant will select a project from a pre-determined group and will be expected to produce an agreed-upon outcome for the non-profit organizational partner. Team Project activities are above and beyond the 100 hours of session time. CLS participants should plan to devote between 20-50 additional hours to the Team Project during the Community Leadership Series.

COMMITMENT
By submitting this application, I understand and affirm that the purpose of the Community Leadership Series is to increase my awareness and understanding about the Capital Region while learning the principles and practices of servant leadership. If selected, I will devote the time and efforts necessary to complete the program. I understand the expectations, agree to be bound by them, and upon graduation will seek meaningful ways to benefit the community through active participation.

All participants will be issued a liability waiver form upon acceptance into the program.

"*" indicates required fields

Expectation Checkbox*

I have read the expectations, and if selected to participate in the Community Leadership Series, I agree to be bound to the terms.

Applicant Information

All information is for internal record-keeping purposes only. Business contact information will be shared with the class members at the launch of the program.

Name*

First Middle Initial Last Preferred First Name

Birth Date*

Employer*

Profession / Industry*

Title*

Home Phone*

Cell Phone*

Business Phone*

Home Email*

Business Email*

Home Address*

Street Address City State ZIP Code

Business Address*

Street Address City State ZIP Code

Preferred Phone Number*

Home

Cell

Business

Preferred Email*

Home

Business

Preferred Mail To*

Home

Business

Race / Ethnicity*

Age*

Gender Pronouns*

Were you referred by an LHA Alum?*

Please list name of the LHA Alum*

How did you learn about LHA?*

How many years have you lived in the Capital Region?*

Education and Professional Training (Exclude High School)

Awarding Institution 1*

Degree or Certificate*

Year*

Awarding Institution 2

Degree or Certificate

Year

Awarding Institution 3

Degree or Certificate

Year

Employment (List 3 Previous Employers Beginning with Most Recent)

Employer 1*

Title or Position*

Dates*

Employer 2

Title or Position

Dates

Employer 3

Title or Position

Dates

Professional References

Reference 1 Name*

Reference 1 Email*

Reference 1 Phone*

Reference 1 Employer*

Reference 1 Position / Title*

Length & Nature of Acquaintance with Reference 1*

Reference 2 Name

Reference 2 Email

Reference 2 Phone

Reference 2 Employer

Reference 2 Position / Title

Length & Nature of Acquaintance with Reference 2

Reference 3 Name

Reference 3 Email

Reference 3 Phone

Reference 3 Employer

Reference 3 Position / Title

Length & Nature of Acquaintance with Reference 3

Essay

Please respond to the following questions in a short essay and upload the file per directions below. Failure to answer the questions will result in the applicant receiving no further consideration.

Describe significant past or current community service experiences and explain how such experiences impacted you personally or professionally. As a result of participating in the Community Leadership Series, how will you make a difference in your home, workplace, and/or the community? Please list any organizations with which you have or have had a significant volunteer role.

Upload File*

Drop files here or

Accepted file types: pdf, doc, Max. file size: 20 MB.

Payment Information

Tuition for the Community Leadership Series is $3,500.
Please do not send any payments with this application. Upon acceptance into the Community Leadership Series, tuition information will be sent in writing.

Applicant Responsibility*
Upon acceptance into the Community Leadership Series, I agree to make a minimum personal financial contribution of $250 toward the $3,500 total tuition (unless otherwise arranged with my employer.) Please check the box below to affirm. I understand that, if accepted, it is my responsibility to secure tuition payment from my employer based on the invoice that LHA will send to me in mid-July. Representatives of non-profit organizations: if a scholarship is awarded, it will be reflected on the invoice and payment due will be adjusted accordingly.
I accept the terms outlined above regarding payment of tuition.

Employer/Sponsor Responsibility

The Employer/Sponsor Page must accompany this application. If an applicant is self-employed or does not have a sponsor, they will be responsible to pay the entire tuition amount.

Download Form

Upload Employer/Sponsor Form File*

Drop files here or

Accepted file types: pdf, doc, Max. file size: 20 MB.

My Sponsor's Name*

My Sponsoring Organization*

Scholarships

A limited number of partial scholarships are available for representatives of non-profits or community-based organizations. Scholarships are issued in accordance with funds available and there are no guarantees. If you would like to apply for a partial scholarship, please indicate the dollar amount needed (up to $1,500) and explanation for the need. Scholarship recipients will be notified in writing along with full payment details.

Amount Requested

Please Explain in 250 Words or Less

Please enter any additional notes or comments below.

Date*

Successful candidates will be advised of acceptance and will receive further instructions via email prior to July 26, 2024. Questions or comments may be directed to 717.216.5200 or emailed to LHA@leadershipharrisburg.org.

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