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PARTICIPANT APPLICATION To be considered for participation in the 2011-2012 Lifework Leadership class please complete this application and submit it to: Jill Slater, Sandberg Leadership Center, Lifework Leadership, 910 Center St., Ashland, Ohio 44805 Standard tuition for Lifework Leadership is $2,500.00. Upon approval of your application, a $500 deposit will be required to reserve your place in the class. The deposit will be credited to your tuition amount. Remainder of tuition will be due by August 30, 2011, unless alternate payment arrangements are requested and approved. Tuition will be reduced to $2,000.00 for those submitting an application and deposit by June 30, 2011. Scholarships are available for qualifying applicants with legitimate need. For a scholarship application, please contact Jill Slater at 419-289-5486 PERSONAL INFORMATION Name (First, Last, Middle Initial): Date of birth:

Phone:

Cell Ph.:

Current address: City:

State:

ZIP Code:

Email:

Referred by: EMPLOYMENT INFORMATION

Current employer:

Organization Type:

Employer address: Phone:

Fax:

City:

State:

Position:

E-mail:

ZIP Code:

EDUCATION INFORMATION Name of Most Recent School: City/State: Major, if applicable: Highest Level or Degree: SPIRITUAL INFORMATION Name of Church/Spiritual Community : Church address (City/State): Name of Pastor/Priest: Roles/Ministries in which you currently participate: PLEASE PROVIDE TWO REFERENCES Name

Address (City/State)

Phone

PERSONAL JOURNEY AND EXPECTATIONS On the back of this application, or on an attached separate sheet of paper, please briefly describe the following: 1) Your personal spiritual journey 2) Your reason for applying for Lifework Leadership, and your expectations from the experience SIGNATURE I authorize the verification of the information provided on this form as it pertains to participation in Lifework Leadership Signature of applicant:

Date:


Lifework Leadership Ashland Application