Test Application Name* First Last Work Email* We will send a copy of your registration form to this email address.Personal Email* To be used in the future for SLI Alumni events.Employer or Sponsoring Organization*Job Title or Leadership Position*The Leslee Niethammer Scholarship The Leslee Neithammer scholarship was established in honor of Leslee Neithammer who died March 11, 2016. Since SLI's inception, Leslee, in addition to her responsibilities as the Director of The Saline District Library, was the person behind the scenes managing all of the administration for the program. She made sure the classes were well organized and presented each year. This need-based scholarship was established for individuals who may not have the financial resources to attend. Please choose a payment option listed below, including if you are in need of being considered for the Leslee Niethammer Scholarship. ***** Limited full and partial scholarships are available based upon financial need.* Please consider me for the Leslee Niethammer Scholarship Please invoice me. Credit Card or Payment Plan. (Visit Saline Community Ed to pay by credit card.) Address* Street Address City State / Province / Region ZIP / Postal Code Daytime Phone*Evening Phone*Community Involvement*Please enter organizations, dates, and what your involvement is.Tell us what each individual’s responsibility is in improving the quality of life in our community:*Tell us why you want to participate in the Saline Leadership Institute:*List 1-3 leadership goals/skills you'd like to develop:*How did you hear about Saline Leadership Institute?*Do you have any dietary restrictions/preferences? Please provide detail in box below.*Agree to the following terms* *To attend the kick-off retreat in January 2022 (Jan. 18th and 19th) and at least 6 of the 7 monthly sessions (Feb. 24th, Mar. 17th, Apr. 21st, May 19th, Jun. 16th, Jul. 14th, Aug. 11, 2022) to receive a Certificate of Completion. *I agree to pay the $595 tuition fee by November 1, 2021 to receive the early registration discount or the regular fee of $645 by December 15, 2021. The total or a partial tuition fee will be cancelled if you have applied for and been granted the Leslee Niethammer scholarship. *I acknowledge that photos will be taken during the sessions and may be used in SLI publications, articles, website and/or social media (Facebook, Instagram, etc.). Continuing Education Credit I would like to receive continuing education credits upon completion of this course. CAPTCHA
