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LA 43 PROGRAM APPLICATION
Save & Return
IMPORTANT: This form may take you 30 minutes or more to complete. If you do not think you will finish in one session, you must either create an account now by clicking the "Log in" button on the right or by clicking the "Save Progress" button at the bottom of the form. Clicking either button will prompt you to set up an account which will then allow you to return and complete a partially finished application.
Log in
BIOGRAPHICAL INFORMATION
First Name
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Middle Name
Last Name
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Name which you prefer to go by:
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Date of Birth - mm/dd/yyyy
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Highest Level of Education
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High School
Some College
Associates Degree
4 year College Degree
Master's
PhD
Other
Gender Identity
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Race/Ethnicity
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African-American or Black
Asian or Pacific Islanders
White
Latino/Latinx or Hispanic
Native American
Other
Other
Year Moved to Asheville
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PREFERRED CONTACT INFORMATION
Mailing Address: Street Line 1
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Street Line 2
City and State
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Zip
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Preferred Phone
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Cell (If not already provided as preferred phone)
Email
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Please repeat email address for accuracy
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PRESENT EMPLOYMENT
Organization/Employer
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Job Title/Position
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Business Sector
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For Profit/Private (25 + Employees)
For Profit/Private (1-24 Employees)
Government/Education
Nonprofit (25 + Employees)
Nonprofit (1-24 Employees)
Duties and Responsibilites
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EMPLOYMENT HISTORY: Please list your most recent previous employer.
Organization/Employer
Duties and Responsiblities
Length of time in this position
EDUCATION HISTORY: Provide up to two (2) beginning with the most recent.
School
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Major
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Degree
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A.A.
B.A
B.S.
M.A.
M.S.
M.B.A.
M.P.A.
J.D.
Ph.D.
E.D.
M.D.
D.C.
Other
School
Major
Degree
A.A.
B.A
B.S.
M.A.
M.S.
M.B.A.
M.P.A.
J.D.
Ph.D.
E.D.
M.D.
D.C.
Other
VOLUNTEER, CIVIC AND COMMUNITY INVOLVEMENT: Describe up to two (2) current or past experiences, beginning with the most recent, and not including professional or business affiliations.
Organization
Position Held
Number of Years Involved
Organization
Position Held
Number of Years Involved
PERSONAL REFLECTIONS: Please keep your responses to 400 words or less.
What are you seeking from your LA Program experience?
In your judgement, what is the most pressing problem or opportunity facing our community today? Why? Give your recommendations for approaching and resolving this problem/opportunity.
What unique strengths, background, identities, and attributes will you bring to the LA Program learning experience?
How would you bring a commitment to equity and inclusion to this experience?
What do you love most about Asheville and why?
Is there anything else you would like us to know?
What learning aspects of the Leadership Asheville Program interest you most?
Personal Leadership Development
Community Awareness/Orientation
Both
REFERENCES: Please list two (2) people who are knowledgeable about your leadership experience or potential, ethics, and maturity.
Name
Phone
Email
Name
Phone
Email
TUITION INFORMATION - Please note that a separate form must be completed if you are requesting financial assistance. You many access that form by copying and pasting the following URL into your browser: https://fs30.formsite.com/LeadershipAsheville/1xcwse0x9o/index.html
Tuition will be paid by:
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Employer
Participant
Other (financial assistance or other sources)
Other (financial assistance or other sources)