Apply Please review the Day Chair Responsibilities and Policies and Procedures for Program Applicants before completing the application. Need to convince your boss? Use the Convince Your Boss Email Template! Step 1 of 4 25% Personal InformationName* First Last Home Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific 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 InformationOccupation*Employer*Employer Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Community Involvement*Please list present or past organization involvement in your communityOrganizationPosition Held/ResponsibilitiesYears Involved What do you hope to gain as a participant in LINC Redwood County?* Demographic InformationThe answers to the following questions are optional. We are requesting this information because one of the goals of the program is to have a diverse group of individuals in each cohort.Gender Female Male Age 18-30 31-45 46-60 60+ Race/EthnicitySelect all that apply African American/Black Asian Caucasian Hispanic/Latino Native American Other ProgramRequirements*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 15 and applicants will be notified of the status of their application by August 15. I understand that I am expected to attend all sessions and activities from 8:30am 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 AssistanceProgram tuition is $450 (that’s $50 per session!); if selected will be payable no later than September 12, 2018. 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). 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* Date Format: MM slash DD slash YYYY