BCDA Loan Program

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Birthday*

Place of Employment and Occupation*

If any, list the current activities you're involved in or N/A.*

What kind of community or volunteer activities would you like to become involved with in the future?*

Why would you like to participate in the 2023 Emerging Leaders Academy Program?*

What has prevented you from getting involved in the involvements you're interested in?*

Personal References

Please list two persons who are knowledgeable about your leadership performance and potential.

Personal Reference 1: Name/Relation/Contact Information

Personal Reference 2: Name/Relation/Contact Information

Do you understand that in order to participate and graduate from the program, you must attend each curriculum session (dates outlined on Program Schedule) and actively participate in the group project?*

Yes
No

Thank you for your interest in participating in the 2023 Emerging Leaders Academy. All applications will be reviewed and selected applicants will be announced on December 28, 2022. If you have any questions, feel free to type them below, or reach out to Michelle Olson at bcdasec@boone-county.org.

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