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LEADERSHIP LAMAR COUNTY APPLICATION |
Date
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E-Mail
Address
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Name (Last; First; Middle)
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First Name or Nickname You Want Used
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Age
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Male or Female
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City of Birth
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Home Street Address
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City/Zip
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Home Phone Number
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Business Street Address
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City/Zip
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Business Phone Number
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If Married : Spouses Name
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Number of Children
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Children's Names
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Hobbies
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EDUCATION
(Begin with High School(s), then college(s),
business or trade school(s) and/or other specialized training.)
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EMPLOYMENT
(Account for all periods including military
active duty.)
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Present Employer
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Date Began
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Present Title or Responsibility
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Since Date
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| Previous Employment (in reverse chronological order) |
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What do you Consider your highest responsibility, skill, or career
achievement?
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REFERENCES
(Name two persons in Lamar County who could
tell the Admissions Committee about you.)
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COMMUNITY ACTIVITIES
(List key community, civic, professional,
business, religious, social, and other organizations of which you have been a
member.)
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Special honors or awards for leadership activities.
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What have you accomplished in these activities that you think is important?
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COMMITMENT
LEADERSHIP LAMAR COUNTY is planned to be a learning experience and requires
attendance at the full-day retreat and monthly meetings which are half-day
sessions over an (8)-month period. Each participant will be expected to
be present, and a plaque will be awarded for successful completion of the
program.
I understand that any participant who is absent in excess of
the one (1) meeting will not graduate with the class and will be required to
make up all classes missed the next year in order to graduate with that class.
I also understand that the $275.00 fee will not be refundable after the
orientation meeting.
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What do you hope to gain from participation in LEADERSHIP LAMAR COUNTY and
what do you think you would give to this community as a past participant in
the program?
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How did you first become interested in LEADERSHIP LAMAR COUNTY?
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If your nomination is sponsored by a company, organization, or institution,
please name.
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Do you have the full support of your employer for the time required to
participate?
Yes
No
Not Applicable
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If selected for the program, my tuition fee of
$275.00
will be paid by :
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Will your company, organization, or institution pay the cost?
Yes
No
Not Applicable
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Do you request partial financial assistance to pay the tuition fee?
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| COMMITMENT PLEDGE |
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1. I wish to participate in LEADERSHIP LAMAR COUNTY.
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| 2. I have my company's/organization's support for my
participation. (if applicable) |
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3. I will be able to attend the Retreat and the eight
(8) monthly sessions |
4. I will have my check for the
$275.00 tuition fee in
by
, 20 |
Signature
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