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Lewis County Leadership Academy Application

Application Deadline: July 1, 2025

 

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Full Name *
Preferred Name (if different)
Email Address *
Cell Phone Number *
Business or Employer Name *
Business or Employer Address *
Current Title
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Education

Name of School City? *
Degree *
Name of School City?
Degree
Additional Work Experience or Certifications:
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Interest in Lewis County Leadership Academy

What do you hope to gain from your participation in the Lewis County Leadership Academy? *
Describe what you feel are the three (3) biggest strengths in Lewis County *
Describe what you feel are the three (3) biggest opportunities in Lewis County *
How did you hear about the opportunity to participate in the Lewis County Leadership Academy *
Do you have employer support to participate in Lewis County Leadership Academy?
YES
NO

FOR NONPROFIT ORGANIZATIONS WITH UNDER 20 EMPLOYEES: You may request tuition assistance through a partnership with the Northern New York Community Foundation. 


Please complete and submit the attached form below:

Submit Your Form Requesting Tuition Assistance:
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Commitments

To complete the Lewis County Leadership Academy, your full participation is required. You must notify staff if you are unable to attend a session and are allowed 2 absences. Take a look at the tentative schedule before submitting your application. Please note that sessions are subject to change and staff will provide at least one (1) week notice of any session changes, excluding emergency events (ex. weather related cancellations).

Are you committed to attend and participate in all program sessions?*
YES
NO
Are you committed to participate in your individual leadership growth plan and partner project?*
YES
NO
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Agreement

Tuition for the Lewis County Leadership Academy is $850 for Naturally Lewis Members and $1,000 for Non-Members. Participants that are accepted into the program will be notified and payment is due prior to the first session. If you require financial assistance, please contact Naturally Lewis for availability. Please list below the billing contact, if you are accepted into the program.

Do you have your employer's financial support to participate in Lewis County Leadership Academy?*
YES
NO
Billing Contact Name *
Billing Contact Email *
Billing Contact Phone Number *
Additional Comments:
Today's Date *
Full Name *
Signature *
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