emerging leaders

Participant Agreement

"*" indicates required fields

Name*

First Last

Preferred Pronouns

Preferred Mailing Address*

Home

Work

Address*

Street Address Address Line 2 City State ZIP Code

Preferred e-mail address*

Enter Email Confirm Email

Preferred Phone Number*

Name as you would like it to appear on your official name badge:*

First Last

Please enter the information below as you would like it to appear on the press release.

Name*

First Last

Job Title*

Organization*

Program Information

Do you have any dietary restrictions? If so, please indicate:

Do you require any special accommodations? If so, please describe your needs:

Emergency Contact

Name

First Last

Phone

Relationship To You

Schedule

Click to view the Spring 2025 Emerging Leaders Calendar

Participation in the program requires a commitment to be present at all seminars. By completing and submitting this agreement, you are making that commitment.

The Civic Action Project component of the program will require you to meet with your team outside of seminar days (on average 6-8 hours per month) to be determined by the team.

Financial Obligation

Tuition / Scholarship*

Tuition is $1000. Please indicate who the responsible party will be for your tuition below.

Applicant/Self

Employer

Other

To be considered for tuition assistance, please complete the form by Wednesday, December 18, 2024: Scholarship Application

All program fees are non-refundable. Tuition payment is due no later than March 10, 2025, and may be paid via credit card here.

By submitting the participation agreement, you acknowledge that you are aware of the time, attendance, conduct, and financial requirements of the program and that you understand and agree that you may be dismissed from the program if you fail to meet the qualifications for participation, including but not limited to:

Failure to pay nonrefundable tuition fees by March 10, 2025.
Engaging in unprofessional, disruptive, or improper conduct or any other behavior that is contrary to the values and mission of FOCUS St. Louis.

By submitting this participation agreement, you understand and agree that failure to meet any of these expectations may result in dismissal from the program. FOCUS St. Louis reserves the right to withdraw an offer of program participation or dismiss a participant from the program for any reason in its discretion.

Please check the box below to indicate your participation*

I will participate in the Spring 2025 Emerging Leaders program.

I will NOT participate in the Spring 2025 Emerging Leaders program.

Name*

First Last