FINAL LEADER PAYMENT REQUEST

Please complete and submit the form below to request your final leader payment once you have completed your cohort.

*Leadership payments are processed during our biweekly payroll.

Cohort Leader Name

First Name

Last Name

Cohort Leader Email

Cohort Number

Did you receive a partial Cohort Leader payment at the beginning of your cohort?

Yes

No

Cohort Graduation Date

Graduating Participants

Please let us know which members of your cohort will be graduating.

Regional Representative Name

First Name

Last Name

NLT Member/Partnership Name

First Name

Last Name

Notes

Please use this space for any additional information we should know.

Did you have a co-leader/assistant?

If so, please tell us their name and email address.

What percentage of your cohort leader payment would you like your co-leader/assistant to receive?