LNU Member Application









    *Full Name:

    Age (Optional):

    *Email Address:

    *Company Name:



    *Work Phone:

    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: