Thank you for your interest in Club Leadership Education. This application will be reviewed by the Nebraska-Iowa District governor, governor elect and Club Leadership Education Committee. Upon review and acceptance, you will be contacted with additional information. 

*Name:(Required.)

Kiwanis Member Number:

*Club Name:(Required.)

Email:

Phone Number:

*I am applying for CLE trainer...(Required.)

certification for the first time.

re-certification.

I am willing to participate in Nebraska-Iowa District’s Certified Instructor orientation or pre-CLE session planning.

Yes

*I am willing to make a three-year commitment to the CLE program.(Required.)

Yes

No (please offer more information in comment section below)

*I am willing to facilitate education/training for (check all that apply)(Required.)

President

Secretary

Treasurer

Membership

*I am willing to offer training sessions that are (check all that apply)(Required.)

In Person

Virtual

For in person training, I am willing to travel (Travel reimbursement is available from the district.)

in my region only 

in my region and nearby regions

anywhere in district

Other (please specify)

I am available to help division and district leaders plan other types of education programs. (Such as Club Leadership Chats or education programs at conventions)

Yes

No

*I agree to use material provided and facilitate training as required by Kiwanis International and Nebraska-Iowa District.(Required.)

Yes

I agree to participate in any evaluation process for certified instructors.

Yes

*Number of years in Kiwanis:(Required.)

*Please list leadership or officer roles (current or past) in club, division, region or district:(Required.)

Other information you would like the district to know about your application: