Good Neighbor Awards Application

Applicant Name(Required)

NOR Leadership Academy(Required)

Yes

Primary Contact Phone(Required)

Email(Required)

Present Firm(Required)

Present Firm Position(Required)

Present Firm Start(Required)

Previous Firm 1

Previous Firm 1 Position

Previous Firm 1 Start Date

Previous Firm 2

Previous Firm 2 Position

Previous Firm 2 Start Date

Please list any Professional Designations you hold:

What are you hoping to achieve from participating in the Leadership Academy.(Required)

Terms and Conditions of Enrollment(Required)

I understand that participation in the Leadership Academy classes is interactive and requires the attendance of every student for all students to receive the full experience of the program.
I know that attendance is a very important part of this program and I am expected to attend all sessions. I acknowledge that Attendance at all programs is mandatory and if I fail to attend I may be asked to withdraw, with no refund of tuition.
I understand the total tuition cost is $250, and the remaining balance will be due by September 3, 2021
certify that the answers I have provided in this application are true and correct.

I accept the Terms and Attach My Digital Signature