Nollau Leadership Institute Application Advocacy Menu Nollau Institute OverviewCurriculumCapstone ProjectsScheduleTuitionFacultyApplication FormDiakonal Minister Community Mail checks payable to "CHHSM" to: The Council for Health & Human Service Ministries, UCC PO Box 91456 Cleveland, OH 44101 Online Application Form: Class of 2026-27 Δ About YouName* Rev.Mr.Mrs.MissMs.Dr.Prof. Prefix First Last PronounsCreating an explicit culture around sharing pronouns is one way to support people's right to determine how they want to be addressed, and affirms the dignity of trans, non-binary, intersex and gender non-conforming people. If you choose not to share your pronouns, we honor this decision and expect that you respect how others in the space wish to be addressed. CredentialsIf you have any academic or professional credentials that you would like us to know about, please list them. Home Address* Street Address Address Line 2 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 Cell Phone*Email Address* Please list the email address you’d like us to use to communicate with you. Emergency Contact Name*Emergency Contact Number*Religious or Spiritual AffiliationCultural BackgroundIn relation to your cultural background (broadly defined as race, class, sexual orientation, ethnicity, gender identity, age, disability, language, country of origin, immigration status, etc.), what identities are important to you that will be helpful for us to know about? CHHSM is committed to issues of Race, Diversity, Equity, Inclusion and Justice and creating a diverse learning community. We recognize how demographic identities and their experiences are not monolithic and deeply appreciate you taking time to complete this section of the application.AccommodationsDo you require accommodations to participate at any point in this process (audio/visual, for on-site trainings: dietary, allergies, mobility, etc.)? If so, please specify above.Share Your PassionFree Response*Please use this space to briefly share why you wish to participate in the Nollau Leadership Institute and two expectations you have of this leadership formation program. Employment InformationJob Title*Employer*Work Address* Street Address Address Line 2 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 Work Phone Number*A brief description of the work your organization does and your role there*FinancialName and Billing Address for tuition and room and board expenses. Some organizations sponsor their employees or members to attend Nollau while others may pay for the program individually. Billing Name First Last Billing Email Address* Billing Address* Street Address Address Line 2 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 We have a limited number of Legacy Fund scholarships available which cover the tuition cost. Are you interested in this scholarship opportunity?*Select oneNoYesPlease note: The Nollau Leadership Institute class members must commit to fully participating in every session of the Institute and the Nollau Online Forum. CAPTCHA