2024-2025 Application

If you have any questions about the program or this application, please email Ellen Klima, SCIL Coordinator, admin@saukcountyinstituteofleadership.org

Name

First Name

Last Name

Email (where you would like all SCIL communications sent)

Home Address

City

Zip Code

State

Phone

Mobile

(###)

###

####

Phone

Work

(###)

###

####

Employer

Employer Address

Employer City

Employer State

How many years have you lived in the Sauk County area?

How did you hear about SCIL?

Why do you want to be a participant in this program? What do you hope to gain from the experience?

What do you believe to be the most significant issues/challenges facing Sauk County?

Individual Commitment

To graduate from the Sauk County Institute of Leadership, a participant is required to attend all sessions - one full weekday each month, September through May. By signing your name below: I understand the purposes of the Sauk County Institute of Leadership program and, if I am selected, I will devote the time and resources necessary to complete the program. I understand that attendance at all monthly sessions is critical to the understanding of the program. Absences for personal or professional reasons must be approved in advance by the SCIL program coordinator or Board of Directors. Even though emergencies do arise, I understand any person missing a portion of two or more sessions may be asked to withdraw from the program, with no portion of the tuition to be refunded.

Date

YYYY

Photo Release

By signing your name below: I grant permission to SCIL to use my photo and comments in SCIL reports, articles, and publications designed for educational, informational, and promotional purposes. I understand some of these materials may be posted on the internet for a period of time.

Date

YYYY

Will you need financial assistance to participate in the program?

If YES, you will need to submit a letter indicating: A) Your need for the scholarship and why you should be granted a scholarship. *Note that the amount of funding available for scholarships depends on the number of requests received. Knowing that: B) Would the lack of receiving a scholarship prevent your ability to participate in the program? C) Is the applicant able to make a partial payment or are they requesting a nearly full scholarship? (*Note that SCIL does not typically grant full scholarships. If a scholarship is granted and does not cover all the costs, is the participant still able to attend?) D) If you have asked your employer [or other sponsors] to support you with full or partial payment. The SCIL Finance, Structure, and Scholarship committee will determine the amount of the scholarship Please send letter to: admin@saukcountyinstituteofleadership.org

Do you have any special dietary requirements? If so, please list: