Fields marked with a * are required.
Section 1: Personal Information
Nickname (name you would like us to use)
Where do you prefer to receive postal mail? Home or Work
If you are selected, would you like to apply for financial aid?
Section 2: Current Employment
Length of Time at Current Employer
Briefly describe your job responsibilities.
What do you consider to be your most significant contribution or achievement related to your work?
Please list past employers, titles, and dates of employment:
Section 3: Education
Please list your educational background.
Section 4: Short Essays
Please list any organizations you are involved in (civic, religious, political, professional, social, and others) and tell us how and why you became involved with them.
How did you find out about Leadership Upper Valley?
Why do you want to participate in Leadership Upper Valley? What do you expect to gain from it and what will you bring to it?
What will be challenging about dedicating a substantial level of time, energy, and attention to this program? How do you intend to address these challenges?
What do you think are the three most important issues impacting the Upper Valley and why?
Section 5: References
Applications will be considered complete once we receive your online application as well as two reference letters. Please have these two letters of recommendation sent directly to: Leadership Upper Valley, Vital Communities, 195 North Main Street, White River Junction, VT 05001 or emailed to email@example.com.
Please list the names, addresses, emails, and phone numbers of two references you have asked to submit letters on your behalf (please make sure that one is from your present employer, if applicable). Choose individuals who are knowledgeable about your leadership potential and performance.
In order for your application to be considered, these boxes MUST be checked:
I understand that the cost of the program is $1350. A deposit is due upon acceptance and the balance is due in full by August 1. Tuition is non-transferable and non-refundable.
Yes, I have read and I understand the participant responsibilities of all Leadership Upper Valley participants. I am able to fully participate in Leadership Upper Valley.
If my application is approved and I elect to participate in Leadership Upper Valley, I hereby authorize Vital Communities and its agents and employees to use my photo image in any and all photographic, video, audio, digital, or other media, and to use, produce, and edit any such recording or image, including my voice and image in personally identifiable form, in such a manner as they or any of them shall see fit, for any purpose, in all media, throughout the world, an unlimited number of times in perpetuity, including distribution over the Internet and its World Wide Web, and including use in modified form and in combination with other images or recordings. I further authorize Vital Communities to transfer or license the rights granted under this Consent and Release to third parties for purposes consistent with the mission of Vital Communities.