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Lakeland’s Hispanic Leadership Program Application Form

PERSONAL INFORMATION

EMERGENCY CONTACT

DEMOGRAPHIC INFORMATION

The requested information will assist the Hispanic Alliance as we gather data for resource development. All information is confidential. Data is presented in the aggregate.

CONFIRMATION OF APPLICATION

By submitting this application, I affirm that I have read the complete application and that, to the best of my belief and knowledge, the information I have provided is complete and accurate. I agree to the following:

1. Know the program information.
2. Attend Orientation Meeting.
3. Attend all scheduled sessions.

MY SIGNATURE BELOW AFFIRMS THAT I UNDERSTAND AND AGREE TO THE RESPONSIBILITIES AND COMMITMENTS RELATED TO THE PROGRAM.