2025-2026 Community Leadership Institute Application Form (Clark County)CLI Applicant ProfileFirst Name: *Last Name *City *State *Zip Code *Telephone *Email *How did you hear about the Community Leadership Institute? *Are you currently involved or working with any non-profit, community-based organization, labor union, or governmental organization in Clark County? *YesNoIf so, which one(s)? Community Affiliation *List 1-3 “communities” to which you say you are most closely connected and would represent as a member of the CLI? (For example, People of Color, Immigrant/Refugee, LGBTQ, White Allies, Low-Income, a Neighborhood Group, Youth Voice, Public/Subsidized Housing Resident, Faith-Based Organization, Union/Labor, etc).Please list 2 people or organizations that can serve as your reference (contact info preferred but not required yet) *Below are some questions about your identities. You are not required to answer any questions you do not wish to answer.What is your current age? (Please enter a whole number) What is your gender identity? What is your racial identity? (Please answer in any way that feels meaningful to you). Essay QuestionsUpload Essay below Please respond to the following essay questions: 1) What is your interest in joining the Community Leadership Institute? How will serving on a municipal board or commission advance your community’s interests? 2) Please describe any racial equity and social justice career aspirations you may have and how these would be supported by your participation in the CLI and eventual placement on a municipal board or commission. 3) Please tell us about previous work, education, volunteer experience, and/or lived experience that you believe have provided you with a strong foundation as an advocate for racial and social justice. You may choose to articulate these questions in one essay, or you may divide them up into sections. You may write as many words as you need to express your answers, however, an essay that is shorter in length is preferred.Resume OR Record of Professional and/or Educational Experience Please submit only one of the following documents: A) Current resume: Please include the most recent version of your resume. Include work, educational, internship, and/or any type of volunteer experience related to community/social services and race and social justice issues. Please label your resume in the following way: Your Last Name – Resume; --OR-- B) Record of professional and/or educational experience: Please include a current, clearly outlined list of professional, volunteer, or educational experiences where you have been exposed to or engaged in addressing social justice and/or racial justice issues. Please list your experiences in chronological order and label the document in the following way: Your Last Name – Record of Professional and Educational Experience.Optional Video Submission Sometimes our writing does not capture the skills that we possess, or the passion that drives our work. If for any reason you wish you submit a video in which you verbally or creatively address the questions asked above, you are welcome to do so. This video submission could be done as a supplement in addition to your written submissions; or this video submission could be done as a replacement instead of a written submission. Please do your best to address the questions. Will you be submitting an optional video? * If yes, please email it to francis@pugetsoundsage.org and title it "[YOUR NAME] CLI Video Submission"YesNo VerificationPlease enter any two digits *Example: 12This box is for spam protection - <strong>please leave it blank</strong>:
