APPLY * Required Field Applicant InformationFirst Name*Last Name*TitleOrganization NameSelect Primary* Work Email Personal Email Work Email* Personal Email* Organization Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Cell Phone*Home Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How did you hear about Leadership Chester County?*Emergency ContactContact Name*Relationship To You*Contact Phone*Application TypeSelect One* Sponsored by Employer Self-Paying Applicant Nonprofit Applicant Nonprofit ApplicantI am currently employed by a nonprofit organizationExecutive Director name*Executive Director email address*Scholarship Request: We want to ensure that cost is not a barrier to participation in Leadership Chester County. A limited number of partial and full scholarships are available. If you would like to request scholarship support, please share a brief explanation of your request (e.g., your organization is unable to fund tuition, limited personal resources, etc.). This section is optional. (150 words or less)Sponsored by EmployerMy employer has agreed to sponsor my participation and will cover the cost of tuition.Name of person responsible for managing tuition*Email Address* Self-Paying ApplicantI will be covering the cost of tuition myself.Scholarship Request Yes, I am Interested We want to ensure that cost is not a barrier to participation in Leadership Chester County. A limited number of partial and full scholarships are available. If you would like to request scholarship support, please share a brief explanation of your request (e.g., your organization is unable to fund tuition, limited personal resources, etc.). This section is optional. (150 words or less)Your Personal WhyWhat sparked your interest in Leadership Chester County, and what do you hope to take away from the experience?*What’s a cause, population, or local issue that you feel connected to, and why?*Nonprofit Board ExperiencePlease list any nonprofit boards on which you currently serve or have previously served. Use the + icon to add additional rows as needed.Nonprofit Board ExperienceAgency NameAreas of focus and target populationsYears of service on boardCurrently on the board?Positions Held Other Volunteer ServicePlease describe any other experiences with nonprofits or other volunteer service. Use the + icon to add additional rows to list all of your experiences.Other Volunteer Service*Agency NameAreas of focusYears of service Supplemental InformationPlease choose one: Link to LinkedIn Profile If no LinkedIn profile, please upload current resume or summary of professional and life experience LinkedIn LinkResume or Summary of Professional and life experienceMax. file size: 50 MB.Resume or summary of professional and life experienceParticipant’s CommitmentIf accepted, I understand the commitment I am making to Leadership Chester County:* I understand that participation in this program is intended for those who are interested in serving in a community leadership role (committee or board position) with a nonprofit, service organization, or other community-focused entity, now or in the future. Attendance at all scheduled monthly sessions is expected. I understand the time commitment required of me as a participant. If selected, I commit to attending all monthly sessions. I fully understand that should I miss more than two sessions, for whatever reason, I will be dismissed from the program with no portion of my tuition refunded (deferral to the following year may be possible on a case-by-case basis). I will make the necessary arrangements to be at sessions on time and remain in class for the full day. I understand that I am required to work on and complete a group project. This will include meetings and work sessions outside of regular class time. I commit to fully participate in and contribute to this project. I understand that there may be additional meetings or activities outside of the scheduled sessions, such as nonprofit board meetings, project-related calls, or optional office hours. While not all are mandatory, I commit to participating as much as possible to support my learning, my classmates, and my contribution to the program. I will exercise discretion with all information shared during the program, both in sessions and through the nonprofit project, so that participants and hosts feel safe discussing sensitive or challenging topics. Some program sessions will take place at various locations across Chester County, such as nonprofit organizations, universities, or community spaces. I understand that I am responsible for providing my own transportation. * By submitting this application, I confirm that I have read and agree to the commitments listed above. Media Release* If accepted, I give my permission to Chester County United Way to use my name, photo, video, voice, and any quotes or statements I’ve made in materials that support and promote their work—especially Leadership Chester County, its fundraising campaigns, or its nonprofit partners. This permission includes the use of these materials in print, online, or broadcast media, and may be shared with trusted partners or media outlets for the same purpose. I understand that I won’t receive any payment or compensation for this use, and I waive any claims related to the use of my image or words. CAPTCHA
