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Leadership Institute: 2025 Southwest Region Application

Leadership Institute Application

Name(Required)
Please upload a copy of your resume
Max. file size: 50 MB.
Home Address(Required)
What is your race? (select all that apply)(Required)
What is your ethnicity?(Required)
What is your gender?(Required)
Veteran Status(Required)
Are you a Minnesota Community Health Worker Certificate holder?(Required)

What school did you attend to get your certificate?(Required)

Employment status(Required)

0 of 30 max characters
Supervisor Name(Required)
Max. file size: 50 MB.
How many hours a week do you work as a CHW?(Required)

Please select all dates that you are ABLE to participate in the Southwest Leadership Insitute in-person in Worthington MN:(Required)

Application Questions

Please answer each question below in 250 words per question (1250 characters max). You may type your answers into the boxes.
0 of 1250 max characters
0 of 1250 max characters
0 of 1250 max characters
This field is for validation purposes and should be left unchanged.