LNU Member Application









*Full Name:

Age (Optional):

*Email Address:

*Company Name:



*Work Phone:

Fax Number:

Cell Phone Number:

Please chose from the following:
My organization/sponsor will cover tuitionI will assume responsibility for the tuitionI am requesting financial support (see below)

Please indicate the sector in which you are employed:


Please complete the following nine questions:

*Why are you interested in Leadership Northern Utah?

*How would Leadership Northern Utah benefit from your involvement?

*What benefits could you gain from the program?

*Are you willing to commit the time & effort to complete graduation required?

*Does your job allow the flexibility to attend the required meetings?

*How long have you been a resident of Northern Utah and how long do you anticipate being a resident?

*Please describe your present position and duties:

*Describe your most important volunteer, civic, and community activities during the past five years, noting any special awards and citations. Include specific examples of your leadership experience:

*List and briefly describe any other accomplishments, skills, and awards you consider significant: