Leadership Southern Indiana DISCOVER Application Step 1 of 4 25% Applicant InformationName* First Last GenderMaleFemaleGender FluidNon-BinaryOther/Prefer not to answerPreferred Pronouns He/him She/her They/them Prefer not to answer Preferred Name* Home Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Personal Email Address* Cell Phone*Please Upload a Headshot* Drop files here or Select files Max. file size: 50 MB. Please be sure that your headshot image is titled with your name.Employment InformationEmployer Name*Job Title*Work Email Address* Work Phone Number*Work Address* Street Address City State / Province / Region ZIP / Postal Code Employer Knowledge Disclosure Please mark if your employer is aware that you are applying Please mark if your employer has consented to be billed for the program Which email do you prefer to have us contact?* Personal Work Both T-Shirt Size*Dietary Restrictions* What are you looking to gain from this experience?*Reference #1 - Name & Phone*Reference #2 - Name & Phone*How did you hear about the program?* Payment Options – We understand that not everyone has an employer paying for their tuition. To that end our board of directors has approved a payment plan option. Once accepted into the program you may chose a 4-payment option, with ¼ of the payment due in the following months (July, October, January & March). Note: Payment is not required until you have been accepted into the program. DISCOVER program participants will be announced in June. Check here to request financial assistance: I would like to be contacted about financial assistance There are five KEY components to your Leadership Southern Indiana DISCOVER Program experience: July 30th, 2025 – ZOOM Kickoff call August 28th and 29th, 2025 – Opening Retreat September 10th, 2025 – Alumni Bash afterwards from 5-7 (optional) September 24th, 2025 October 29th, 2025 November 12th, 2025 December 10th, 2025 January 14th, 2026 February 11th, 2026 March 11th, 2026 April 8th, 2026 May 13th, 2026 – Closing retreat June 3rd, 2025 – DISCOVER Committees Planning Meeting Participation in planning a Class Day for the 2026-27 DISCOVER Program - Dates to be determined by DISCOVER Committee. This will be the year following your graduation. Accept the mission of Leadership Southern Indiana: To engage, develop and mobilize regional leaders who will serve and transform our community. Thank you for applying for Leadership Southern Indiana’s DISCOVER Program! Δ
