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Personal
1. First Name
2. Last Name
3. Home Address
4. City
5. State
6. Zip
7. Personal Email
8. Personal Phone
Professional
1. Business/Organization Name
2. Business/Organization Address
3. City
4. State
5. Zip
Biographical Data Submit a brief autobiography, which includes employment and current community involvement.
Statement Write a brief statement of why you want to be a member of the Sauk Valley Community Leadership Program.
Issue Briefly identify one current issue/topic facing our communities that interests you.
Confirmation
1. If I am selected to be a member of the Sauk Valley Community Leadership Program, I confirm that I will pay the tuition or the tuition will be paid by the following business/organization:
2. Business/Organization
3. By submitting this application, I confirm that my business/organization supports my application and will allow me to attend all class sessions.

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