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Personal Information

Name*

First Last

Home Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

How did you hear about us?*

(co-worker, HR staff, social media, etc.)

What is your connection to Redwood County?*

(living, working, worshiping, or has a child attending school)

Years in Redwood County*

(living, working, worshipping or attending schools)

Occupation Information

Occupation*

Employer*

Employer Address

Street Address Address Line 2 City State ZIP Code

Community Involvement*

Please list present or past organization involvement in your community

Organization

Position Held/Responsibilities

Years Involved

What do you hope to gain as a participant in LINC Redwood County?*

Program

Requirements*

Please indicate your agreement of the following

I understand that completion of this application does not guarantee placement in the LINC Redwood County program. Submission deadline for applications is July 19 and applicants will be notified of the status of their application by August 1, 2022.

I understand that I am expected to attend all sessions and activities from 8am to 4:30pm (not to include travel time).

I have received permission from my supervisor (if applicable) to attend each session.

I understand that tuition is due upon acceptance to the program and must be received prior to the beginning of class unless other arrangements have been made.

I have read the policies and program information and understand the short and long-term expectations for participation in the program.

Tuition and Tuition Assistance

Program tuition is $450 (that’s $50 per session!); if selected will be payable no later than September 1st, 2022. If tuition assistance is needed, please select any of the following for consideration. Request must be submitted at this time.

Please consider my application for tuition assistance as I represent a small business, non-profit organization, or am self-employed.

Please consider my application for community diversity funds for tuition assistance as I represent a minority population.

Please consider my application for a tuition payment plan (due quarterly).

Tuition Assistance Description (please provide a short description of why you are seeking assistance)

Signature*

By submitting this information, I acknowledge my commitment to fulfill the requirements of the program and understanding that my application does not guarantee my acceptance as a participant.

Full Name

Date*

LINC Redwood County Application

Personal Information

Occupation Information

Demographic Information

Program