Ignite Young Professionals Registration Twitter First Name * Last Name * Name You Prefer to be Called Gender male female Birthdate * mm-dd-yyyy Ethnicity Email * Address * City * State * - Select Province/State - Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ==================== Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code * Phone Number Have you previously applied to the Ignite Young Professionals Program? * Employer Name * Employer Website Current Position/Title * Employer Address Employer City Employer State - Select Province/State - Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ==================== Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming What type of organization is your employer? * Company Foundation Government Non-Profit Organization School How long have you worked at this organization? * Briefly describe your job responsibilities: * Employment History * Beginning with your most recent, please list your employment history. Education and Training * Begin with the most recent. Community commitment outside of work: * List your community involvement. This does not need to be limited to Arlington. Other activities and accomplishments * Please list other relevant accomplishments, honors, offices held and activities (including work-related). What do you hope to gain from your Ignite Young Professionals Program experience? * 500 word limit If you had one week to devote to entirely to community service, what would you do and why? * 500 word limit each If you work for a small nonprofit with limited resources, or do not have a sponsoring organization and are experiencing financial need, please indicate the potential need for tuition support here. Scholarships are funded by the generous support of area individuals and businesses, and are dependent on the amount of funds raised each year. Every effort will be made to meet demonstrated financial need. please contact me about scholarship options I understand the mission of the Leadership Center for Excellence. If selected, I will devote the required time and pay my tuition by October 7, 2020. If I am unable to comply with the requirements, I will voluntarily withdraw from the program. I understand that, in the interest of the class experience for all participants, any participant may be removed from the class if, in the opinion of the Leadership Center for Excellence, that participant’s conduct is not conducive to the work of the group. I further understand that tuition is not refundable in whole or in part. Signed (applicant) *
