Lewis County Leadership Academy Application

Application Deadline: July 1, 2025

Full Name *

Preferred Name (if different)

Email Address *

Cell Phone Number *

Business or Employer Name *

Business or Employer Address *

Current Title

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Education

Name of School City? *

Degree *

Name of School City?

Degree

Additional Work Experience or Certifications:

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Interest in Lewis County Leadership Academy

What do you hope to gain from your participation in the Lewis County Leadership Academy? *

Describe what you feel are the three (3) biggest strengths in Lewis County *

Describe what you feel are the three (3) biggest opportunities in Lewis County *

How did you hear about the opportunity to participate in the Lewis County Leadership Academy *

Do you have employer support to participate in Lewis County Leadership Academy?

YES

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Commitments

To complete the Lewis County Leadership Academy, your full participation is required. You must notify staff if you are unable to attend a session and are allowed 2 absences. Take a look at the tentative schedule before submitting your application. Please note that sessions are subject to change and staff will provide at least one (1) week notice of any session changes, excluding emergency events (ex. weather related cancellations).

Are you committed to attend and participate in all program sessions?*

YES

Are you committed to participate in your individual leadership growth plan and partner project?*

YES

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Agreement

Tuition for the Lewis County Leadership Academy is $850 for Naturally Lewis Members and $1,000 for Non-Members. Participants that are accepted into the program will be notified and payment is due prior to the first session. If you require financial assistance, please contact Naturally Lewis for availability.

Do you have your employer's financial support to participate in Lewis County Leadership Academy?*

YES

Additional Comments:

Today's Date *

Full Name *

Signature *

Clear

Submit

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