Application

Leadership Southwest County - Class of 2014

By submitting this form, I certify that all the information I have provided in this application is complete and accurate and all statements are my own work. If selected, I will attend all sessions.

Program Fee: $1499.00. An invoice will be sent upon your acceptance into the program. Payment is due by August 31st, 2013.

*Name (as you wish it to appear)

*E-mail Address

*Phone Number

Home Address

City

Zip

Employer

Job Title

Employer Address

City

Zip

Current Employment

For Profit

Non Profit

Government

Volunteer

Education - Please list Colleges & Degrees

Specific Training Obtained

Leadership Positions/Special Honors

Please list all your volunteer/community activities and the role you played in each:

*What is your definition of community leadership and who exemplifies it best?

*What are your motivating factors for wanting to participate in Leadership Southwest County?

*How do you envision putting the ideas learned during the program into action?

*In what ways do you hope to contribute to the class?

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