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LeadDIVERSITY Application

General Information

Name(Required)
Date of Birth(Required)
Home Address(Required)
Industry Type(Required)
Work Address

Supervisor Information

Please provide Supervisor’s information. We highly recommend you inform your supervisor prior to applying for this program as you will need their consent to participate if selected.
My direct supervisor is aware of LeadDIVERSITY and supports my full participation in the program.
Supervisor Name(Required)

Attachments and Essay Questions

Please attach a resume detailing your education, employment, community involvement or engagement, and any previous diversity training
Accepted file types: pdf, doc, docx, Max. file size: 64 MB.
Accepted file types: pdf, doc, docx, Max. file size: 64 MB.
You are welcome to provide a personal or professional letter of recommendation to support your application. A letter of recommendation is not required to apply.
Please answer the 4 questions below. You are welcome to submit your entries in written or video format. Written response can go in the boxes below or you may submit responses via an attachment and upload it here. Please limit written responses to 500 characters per question. If you choose to submit a video response. Please save it as a YouTube or Vimeo file upload a PDF or DOC with the link to the video file enclosed. Please submit only 1 video for all 4 answers. Please limit videos to no more than 8 minutes. DO NOT UPLOAD VIDEO FILE TO APPLICATION.
Accepted file types: pdf, doc, docx, Max. file size: 64 MB.
Write your response in the box provided, if you are submitting answers as an attachment or a video, enter video or attachment response in the box.
Write your response in the box provided, if you are submitting answers as an attachment or a video, enter video or attachment response in the box.
Write your response in the box provided, if you are submitting answers as an attachment or a video, enter video or attachment response in the box.
Write your response in the box provided, if you are submitting answers as an attachment or a video, enter video or attachment response in the box.
I have submitted the following attachments

Emergency Information

Emergency Contact Name(Required)

Participation Consent & Agreements

In order to accomplish the program’s objectives, the full participation of each individual selected is necessary. Participants may miss no more than one of the scheduled program dates. Participation at each session requires attendance for the entire scheduled day. Missing more than one session will jeopardize participant’s eligibility for graduation.
Session Dates (unless otherwise noted sessions are from 8:30am – 4:30pm):
August 24 8:30am-11:30am – Meet and Greet
Session One – September 20
Session Two – October 11
Session Three – November 8
Session Four – December 13
Session Five – January 10
Session Six – February 21
Session Seven – March 13
Session Eight – April 10
Session Nine – May 8
Session Ten – May 16 8:30am – 1pm
Graduation – June 14 3pm -7pm

APPLICATIONS ARE DUE midnight June 12, 2023
Tuition for each participant in the LeadDIVERSITY Class of 2023/24 is $2,200. Applicants may be sponsored by their employer or may sponsor themselves, with agreement from their employer. A limited number of partial scholarships are available, based on financial need. If you are accepted into the LeadDIVERSITY Class of 2023/24, you and/or your employer will be invoiced accordingly. Payment is due prior to the August Meet & Greet. We do not want the cost to be prohibitive for your attendance, therefore, Inclusive Communities is willing to work with you to mitigate any barriers. Please email brittany@inclusive-communities.org if you need to discuss financial assistance for attending this program.
After reading the above information on tuition, please check all that apply(Required)
Photo/Video Consent(Required)
If I am accepted as a member of the LeadDIVERSITY Class of 2023/2024, I give permission for my photo and/or video image to be used in any publicity materials for Inclusive Communities

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