Application Information - Application

PERSONAL INFORMATION
Name*
First Last
Email*
Phone*
Home Address*
Street Address Address Line 2 City State ZIP Code
County of Residence*
Leadership South Dakota is committed to selecting a diverse group of participants. Your response to the following will assist the Selection Committee in determining class composition.
Ethnicity*
If you are an ethnicity other than what we listed, please specify*
Gender
- Male
- Female
Birth Place*
City State
Birth Date*
MM
DD
YYYY
EMERGENCY CONTACT INFORMATION
Name*
First Last
Relationship*
Phone*
Name
First Last
Relationship
Phone

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APPLICANT REFERENCES
Please provide two references (one personal, one professional). Please notify them that they may be contacted by the Leadership SD staff for further information.

Reference #1
Reference #1 Name*
First Last
Reference #1 Email*
Reference #1 Personal Phone*
Reference #1 Work Phone*
Reference #1 Organization*
Reference #1 Relation to Applicant*

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APPLICANT REFERENCES
Please provide two references (one personal, one professional). Please notify them that they may be contacted by the Leadership SD staff for further information.

Reference #2
Reference #2 Name*
First Last
Reference #2 Email*
Reference #2 Personal Phone*
Reference #2 Work Phone*
Reference #2 Organization*
Reference #2 Relation to Applicant*

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REVIEW

By checking the boxes below, I certify that:
All of the information provided is complete and true to the best of my knowledge.*
- Yes
If selected, I am fully prepared to be an active participant, I commit to attend all sessions, and I agree to devote the time and resources required to complete the Leadership South Dakota program.*
- Yes
Upload Résumé & Headshot*
Drop files here or
Upload Leadership South Dakota Agreement Form*
To complete this application, please upload the Leadership South Dakota Agreement Form with your application.
Drop files here or
Upload Employer Statement Form*
To complete this application, please upload the Employer Statement Form with your application.
Drop files here or
Optional Upload: Tuition Assistance Form
Limited partial scholarships (up to $1,500) are available on the basis of need. Request of financial assistance has no negative impact on the acceptance of your application. If you need financial assistance, you must complete and upload the Tuition Assistance Form with your application.
Drop files here or

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PAYMENT

In order to submit an application for Leadership SD's consideration for the first time, a $50 application fee is required (non-refundable).
First Time Applicant Fee
This page is unsecured. Do not enter a real credit card number! Use this field only for testing purposes.
Payment Information*

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Would you like an email receipt?
- Yes, Please!
If so, we'll send to the email address you designated in Step 1 - Personal Information.
Total
$0.00
Email
This field is for validation purposes and should be left unchanged.

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First Time Applicant