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LSET Class of 2023 Application (new)
Please complete the following form to apply for the LSET Class of 2023.
Thank you,
Maris Peno
Program Director
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Last Name
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Your answer
First Name
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Your answer
Middle Initial
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Your answer
Preferred Name
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Your answer
Salutation
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Ms.
Mr.
Mrs.
Dr.
Other
Residential Address (Street Address)
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Your answer
City of Residential Address
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Your answer
Zip Code of Residential Address
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Your answer
County of Residential Address
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Your answer
Home or Cell Phone Number
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Your answer
Personal Email Address
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Your answer
Length of residency in Southeast Texas
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Your answer
Name of Company/Organization
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Your answer
Business Mailing Address (Street Address)
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Your answer
City of Business Address
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Your answer
Zip Code of Business Address
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Your answer
County of Business Address
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Your answer
Business Phone Number
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Your answer
Business Email Address
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Your answer
Your Position or Title Within Your Company or Organization
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Your answer
Describe your employment responsibilities, type of organization and length of employment:
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Your answer
Are you currently an elected public official?
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Yes
No
Are you a candidate, as a public official, for election or re-election (even if unopposed)any time from September 2022 - May 2023?
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Yes
No
Please list any relevant education and training opportunities that you have completed or are currently pursuing. (Including University, College, Certifications, Apprenticeships, Other leadership programs, etc)
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Your answer
Please list any recognitions, honors and awards that you have received. Be sure to include the organization, location, estimated date and a short description.
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Your answer
Please list and civic, professional, religious, social, athletic or other organizations in which you have been or are a member. Include the organization, dates of affiliation and leadership positions.
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Your answer
I have read the nomination guidelines on the LSET website and understand the time and tuition requirements of the Leadership Southeast Texas program and am prepared to fulfill these requirements.
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Yes
No
My supervisor has been notified of the time commitment of the LSET program and supports my registration.
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Yes
No
How did you hear about LSET or who encouraged you to apply?
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Your answer
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