Project L.E.A.P Application (May 12 - June 23)

It is important that you complete all parts of the application. If your application is incomplete your application may not be accepted. If you have no information to enter in a section, please write N/A.

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Email *
Full Name (First and Last Name) *
Age *
Full Address (Street, City, State, Zip code) *
Cell Phone Number *
Email Address *
What is your current gender identity? *
What sex were you assigned at birth?
 *
My gender pronouns are:
 *
What is your age?
 *
Please specify your race.
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Required
What is the highest degree or level of education you have completed?
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Training Preference? *
The following information is important for the shaping of the L.E.A.P. Program (please check all that apply)
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Required
Name the Agencies you have worked with or are affiliated with? *
How long did you work with the agencies? List Start and End Dates for each agency. *
Project L.E.A.P. participants will receive a stipend for their participation.  A $50.00 stipend will be provided after each LEAP meeting (full day).  Do you agree to receive your stipend via  Check or Zelle?
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Project L.E.A.P. participants will receive a $20.00 credit for on-demand food delivery via GRUBHUB.  Do you agree to receive your food credit via GRUBHUB?
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Why do you want to participate in the L.E.A.P. Program?
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How do you plan to use your new L.E.A.P. skills upon graduation? (ex. Planning Council, CAB, Advocacy)
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If selected, I will attend all scheduled program sessions.  I understand that I must attend a minimum of 80% of the sessions to graduate from the L.E.A.P. program.  I certify that all the statements made in this application are true, complete, and correct to the best of my knowledge, and are made in good faith.  I understand that submitting this application does not guarantee admission in the L.E.A.P program nor does graduation from the program ensure membership to any planning organization, including the local planning councils. 

All information included on this application is considered confidential and is for L.E.A.P. program use ONLY.

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