This form should be completed by the direct supervisor of the program applicant, if possible.
Please read and mark the checkboxes to show your agreement with the following statements.
We appreciate knowing the objectives you have for supporting this Program Applicant, including any specific competencies or knowledge you hope will be developed during the program.
Tuition is payable upon acceptance into the program and is due by September 8, 2017 at the latest. An invoice will be sent to the Employer Contact on this form upon the Applicant's acceptance to the program, if you have identified below that you are paying for some or all of the tuition. Tuition amounts are non-transferable and non-refundable after September 22, 2017.
When employers are funding the seat, participants are asked to contribute $250 as a personal commitment and investment in their professional development.
We provide 2-5 bursaries each year to Program Applicants who experience financial need. Leadership Victoria relies on contributions from community partners and sponsors to fund these bursaries. If your organization is interested in providing a full or partial bursary to another applicant, please select the appropriate option below. A Leadership Victoria staff person will follow up with you by phone.
Please type your full name into this field as acknowledgement of your agreement to the terms and options selected above. This is in lieu of your signature. We may phone the contact listed on this form to confirm.
This field is for validation purposes and should be left unchanged.