Emerging Leader Scholarship

Company

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ABOUT YOU

Name(Required)

First Name Last Name

Email(Required)

Phone Number(Required)

City(Required)

State(Required)

YOUR EDUCATION

Which best describes you?*(Required)

I am currently enrolled in an eligible educational program.

I graduated from an eligible program within the past 12 months.

College, University or Educational Institution(Required)

Degree/Program of Study(Required)

Area of Study(Required)

Nursing

Healthcare Administration

Leadership/Organizational Leadership

Business

Other Healthcare-Related or Leadership Program

Expected Graduation Date or Graduation Date(Required)

Proof of Eligibility(Required)

Accepted file types: jpg, gif, png, pdf, Max. file size: 4 MB.

Proof of current enrollment or graduation within the past 12 months is required to be considered for an Emerging Leader Scholarship.
Please upload documentation verifying your eligibility, such as a current student ID, enrollment verification, class schedule, transcript, or documentation showing your recent graduation date.

TELL US ABOUT YOU

Why would attending Lead on Fire be valuable to you at this point in your journey?(Required)

This year's theme is Lead with Purpose. Live in Peace. What does that mean to you as you prepare for your career and future leadership?(Required)

SCHOLARSHIP ASSISTANCE

Would you be able to attend Lead on Fire with a partial scholarship?(Required)

Yes

I'm not sure

Your answer will not affect whether you are considered for a scholarship. It simply helps us use available scholarship funds to support as many Emerging Leaders as possible.

YOUR COMMITMENT

Scholarships are made possible by individuals and organizations who believe that Emerging Leaders deserve opportunities to learn, grow, and be in rooms where leadership is being developed. Because scholarship funds are limited, we ask that you apply only if you are committed to attending the conference if selected.(Required)

If selected, I am committed to attending the Lead on Fire Leadership Conference on March 4–5, 2027.

I confirm that the information provided in this application is accurate and that I meet the Emerging Leader eligibility requirements.

Scholarship Notification

Scholarship recipients will be selected and notified by February 5, 2027. If selected, you will have 5 days from the date of your scholarship notification to accept your award and confirm your attendance. Scholarships not accepted within the 5-day period will be forfeited and may be offered to another eligible applicant.

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Comments

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First & Last Name(Required)

Title/Organization(Required)

Email(Required)

Phone(Required)

NAB# (for LTC or AL Administrators only)

Breakout Workshop Selection (Day 2: 10:30 AM – 12:30 PM)

Please select one workshop below:(Required)

Transforming Dementia Care: Leadership Tools for Managers in Healthcare and Beyond

Learn practical ways to support staff, reduce burnout, and strengthen person-centered dementia care.

The Genius of Teamwork: Unlocking the Six Working Geniuses in Leadership

Discover how to harness each person’s natural genius to build balanced, high-performing teams.

Total

Price:

Coupon

Total

Credit Card

Special Requests or Dietary Restrictions

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Instagram

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Name(Required)

Company Name(Required)

Email(Required)

Phone(Required)

Current Job Title and/or Qualifications(Required)

Topic of Presentation(Required)

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Sponsor Information

Organization/Business Name(Required)

Contact Person(Required)

Email Address(Required)

Phone(Required)

Mailing Address

Street Address City State / Province / Region ZIP / Postal Code

Sponsorship Options Tier 1(Required)

None

Torchbearer Sponsor – $2,500 (Title Sponsor)

Visionary Flame Sponsor – $1,500

Beacon Blaze Sponsor – $750

Catalyst Spark Sponsor – $500

Steady Ember Sponsor – $250

Lead on Fire Friend – $100

Select Qty

Sponsorship Options Tier 2(Required)

None

Breakfast Sponsor - $500

Break Sponsor (AM or PM) - $300

Speaker Session Sponsor - $750

Quantity

Vendor Opportunities(Required)

None

Yellow Spark Vendor – $150

Payment Information

Payment Method(Required)

Check

Credit Card

Invoice Needed

Yes

Coupon

Total

Credit Card

Additional Notes or Special Recognition Requests

LEAD ON FIRE EMERGING LEADER SCHOLARSHIP

ABOUT YOU

YOUR EDUCATION

TELL US ABOUT YOU

SCHOLARSHIP ASSISTANCE

YOUR COMMITMENT

Scholarship Notification