Leadership Anne Arundel- Build- NLA Registration Form

Neighborhood Leadership Academy Online Schedule and Registration Form

Applications must be received by LAA no later than November 17, 2008

Classes are held Saturdays with the exception of two events* (Bus Tour and Group Project Presentation) which are held on a Monday and a Friday, respectively. Classes generally run from 9:00 a.m. to 4:00 p.m. with continental breakfast and lunch provided on each session day:

November
November 22, 2008 December
December 1, 2008*
December 13, 2008 January
January 3, 2009
January 31, 2009

February
February 28, 2009 March
March 14, 2009 April
April 4, 2009

May
May 29, 2009 June
June 4, 2009 -
Graduation (One additional date TBD)

Please fill out this NLA registration form and submit below.

Name:
I prefer to be called:
I prefer all correspondence sent to:	home business
Home Address:
City:
State:
Zip:
Employer/Organization (if applicable):
Position/Title:
Business Address:
City:
State:
Zip:
Business Phone (w/area code):
Home Phone (w/area code):
Cell Phone (w/area code):
FAX (w/area code):
E-mail Address:
Current Community Involvement If you are already working in community service organizations, what are you doing at the present time?
Participation What possible barriers would you have as part of your commitment to the schedule provided below?
Expectations What do you hope to gain from your participation in the Neighborhood Leadership Academy program?
Vision After completing the Neighborhood Leadership Academy, how would you envision using what you learn?
Referred by:
Today's Date:

You may prefer to download these print forms:
2008-2009 Neighborhood Leadership Academy Application (pdf)
or, Word version

Our Leadership Partners:

Neighborhood Leadership Academy Online Schedule and Registration Form

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