Leadership Application Process

   The goal of Leadership Morehead/Rowan County is to identify and further develop both existing and potential community leaders, who can in the years ahead, assume a dynamic leadership roale in shaping the future of Morehead and Rowan County.  Due to the critical importance of selecting quality candidates for the program, as well as the desire to have each class represent a diverse cross-section of the community, a great deal of informaiton is asked of you in the application.  If you are interested in being a part of the upcoming Leadership Program, please fill out the information requested and return to our office located at 150 East First Street, Morehead, Kentucky.  All applications are subject to confidential evaluation, as a patter of policy, Morehead-Rowan County Chamber of Commerce Leadership Academy does not discriminate among applicants on the basis of race, religion, sex, national origin, age or disability.

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MOREHEAD - ROWAN COUNTY

LEADERSHIP ACADEMY

APPLICATION FORM

            The goal of the Chamber of Commerce Leadership Academy is to identify and further develop both existing and potential community leaders, who can in the years ahead, assume a dynamic leadership role in shaping the future of Morehead and Rowan County.  Due to the critical importance of selecting quality candidates for the program, as well as the desire to have each class represent a diverse cross-section of the community, a great deal of information is asked of you in this application.  Please be as thorough and accurate as possible in your response.  All applications are subject to confidential evaluation.  As a matter of policy, The Leadership Academy does not discriminate among applicants on the basis of race, religion, sex, national origin, age, or disability.

PERSONAL INFORMATION

Name __________________________________________________________________

            Last                                                      First                                         Middle

Home Address ___________________________________________________________

City                                                      State                                                    Zip

Years Lived in Rowan County _______________________________________________

City & State of Previous Residence ___________________________________________

Do You Anticipate Being A Long Term Resident? _____YES______NO _____MAYBE

Home Phone __________________________ Business Phone _____________________

E-Mail Address __________________________________________________________

Birthdate__________________________________

EDUCATION (Beginning with High School)

Name & City of School                        Date                             Degree                         Major

Special Honors, Awards, Prizes for Academic Performance

Extracurricular Activities and Special Honors for Leadership Activities

EMPLOYMENT INFORMATION

Current Employer_________________________________________________________

Position ________________________________________________________________

Responsibilities ___________________________________________________________

Business Address_________________________________________________________

City                                                      State                                                    Zip

Previous Employers                  Title                  From        To               Reason for Leaving

ORGANIZATIONAL AFFILIATIONS AND ACTIVITIES

            Please list, in order of importance to you, up to five civic, professional, social, and religious, community, academic, athletic, or other organizations of which you are or have been a member.  Please note any leadership positions held.

ORGANIZATION                  TITLE/RESPONSIBILITY                  DATES OF

                                                                                                            MEMBERSHIP

REFERENCES

Three references are required in support of your application.

Name/Title ______________________________________________________________

Business Address _________________________________________________________

City                                                      State                                                    Zip

Name/Title______________________________________________________________

Business Address _________________________________________________________

City                                                      State                                                    Zip

Name/Title ______________________________________________________________

Business Address _________________________________________________________

City                                                      State                                                    Zip

EMPLOYMENT COMMITMENT

            Applicants for the Leadership Academy program must have the support and commitment of their business or organization.  To meet graduation requirements, it is necessary that participants attend at least 90% of all scheduled events.  Absenteeism will result in being dropped from the course and the fee to participate will not be refunded.  Your employer’s signature below indicates his/her commitment to your being free to attend all sessions in addition to completing a community project approved by the Morehead-Rowan County Chamber of Commerce Executive Board .

________________________________________________________________________Signature                                              Title                                                      Date                

            List the three most significant problems and/or opportunities confronting Rowan County in the years ahead, and provide us with your thoughts on how those problems/opportunities might most effectively be responded to in serving the community’s best interest.  Attach additional sheets if necessary.

________________________________________________________________________

How much time each month do you customarily commit to community, civic, professional, and other organizations and activities?

Have you been as active in community, civic, professional and other activities as you would like to be?

If not, what have been the major barriers to your becoming involved?

If not, what conditions have changed that now enables you to get more involved?

Why are you applying for admission to the Chambers Leadership Academy , and how do you hope to benefit from your experience in the program?

What do you feel have been your greatest accomplishments in your working career?

What do you feel have been your most substantial contributions to the community?

After successfully completing the Leadership Academy, what degree of effort are you prepared to invest in your continued development?

What do you consider to be your major strengths?

What do you consider to be your most significant development needs, areas in which you would most like to improve?

What types of accomplishments tend to be the most fulfilling to you?

How do you get people excited about trying something new, when nobody is interested in the changes you bring up?

What type of people do you have no patience for, or find annoying?

Do you think some leaders make better decisions than others?  If so, what do you think makes the difference?

What books     a) have you read during this past year?

                        b) Have had the greatest impact on your life, on the shaping of your                                   views?

a)______________________________________________________________________

b)______________________________________________________________________

Why do you feel that at this time you are an ideal candidate to participate in the Leadership Academy program?

            Applications must be postmarked by September 4, 2009.  Because the program is limited in size, we expect we will only be able to accept a portion of those applying at this time. If you are not selected to participate in the current Leadership Academy program, your application will be retained by the committee for consideration of later enrollment.  All applicants will be notified of acceptance or non-acceptance.

            The tuition fee for the Leadership Academy program is $500.00 per year, which may be paid by the individual or by a sponsoring company or organization.  Tuition fees must be paid in full by September 30, 2009.  If you wish to attend and can not pay in full by this time, please contact us so that payment options may be discussed.

            I hereby certify that the information provided herein is complete and accurate.  I understand that if I give false information, if I fail to attend the opening session and/or one scheduled events, or if I fail to meet any part of the obligation of participating, I may be asked to withdraw from the program, without reimbursement.

Applicant’s Signature                                                                Date

PLEASE RETURN TO:

Tracy C. Williams

Executive Director

Morehead Rowan County Chamber of Commerce

150 East First Street

Morehead , KY 40351

(606) 784-6221

email:tcwilliams@moreheadchamber.com