APPLICATION
Leadership Lake Houston is a program of the Lake Houston Area Chamber of Commerce which identifies and develops future leaders for our community. The intent of the program is to develop new community leaders and enhance the skills and community awareness of existing community leaders by exposing participants to the challenges and opportunities in various segments of the Lake Houston Area. The goal of this process is to assemble a network of community leaders who can enhance their problem solving and other leadership abilities through shared perspectives and working together.
2017-2018 Class Schedule (8:30 a.m.-4 p.m.)
DATE / SESSIONAugust 29 / Opening Reception (5:30 p.m.)
September 14-15 / Opening Retreat
October 10 / Social Services
November 14 / Justice and Public Safety Day
December 12 / Government
January 9 / Healthcare
February 13 / Education
March 6 / Business and Economic Development
April 10 / Quality of a Leader
May 8 / Class Project Day/Graduation
APPLICANT NAME:Click here to enter text.
SPONSORED OR REFERRED BY:Click here to enter text.
TUITION: $895 if received by 7/31/17. Late fee of $50 will be assessed on 8/8/17.
APPLICATION CHECKLIST (Deadline to submit all materials is 5 pm, May 26, 2014):
☐One copy of completed application
☐Non-refundable $25 application fee. (Application fee is waived for Chamber members who are at or above the Partner Distinguished Investor level).
☐Three References (Name, Company, Address, Phone Number, Email for each).
*If you are in need of financial assistance, attach a letter explaining your need
IMPORTANT DATES:
May 26: Application DeadlineAugust 8: Tuition Deadline
July 6: Applicant Acceptance NotificationAugust 29: Opening Reception
CONFIDENTIAL APPLICATION FOR APPOINTMENT
LEADERSHIP LAKE HOUSTON 2017-2018
A program of the Lake Houston Area Chamber
PERSONAL INFORMATION DATE:Click here to enter a date.
Please complete the entire section
APPLICANT FULL NAME
PREFERRED NAME ☐MALE ☐FEMALE
COMPANY NAME
BUSINESS MAILING ADDRESSAddress, City, State, Zip
BUSINESS PHONE
BUSINESS EMAIL
PREFERRED EMAIL ADDRESS (If different from Business Email)
HOME ADDRESSAddress, City, State, Zip
HOME PHONE CELL PHONE
EMERGENCY CONTACTNAME & RELATIONSHIP
EMERGENCY CONTACT PHONE
AGE RANGE: Choose an item.
LENGTH OF RESIDENCY IN THE LAKE HOUSTON AREA
HOBBIES
Do you reside AND work in the Lake Houston Area? Y/N.
If “NO”, please explain your motivation for wanting to participate in this program.
EDUCATION
SCHOOL NAME & LOCATION / DATES ATTENDED / MAJOR / DEGREEOther certifications or training programs:
EMPLOYMENT INFORMATION
PRESENT EMPLOYER START DATE Click here to enter a date.
TYPE OF ORGANIZATION
CURRENT TITLE SINCE Click here to enter a date.
RESPONSIBILITIES
LIST PREVIOUS EMPLOYMENT IN REVERSE CHRONOLOGICAL ORDER:
EMPLOYER / TITLE/RESPONSIBILITY / DATES FROM-TO (M/YR – M/YR)BUSINESS/PROFESSIONAL AFFILIATIONS (Not including civic organizations or political activity):
NAME OF GROUP / POSITION HELD / PERIOD OF AFFILIATIONBriefly describe your tenure in your chosen field. Note years of service and describe growth of responsibility.
What do you consider your highest career achievement to date?
COMMUNITY INVOLVEMENT
Include community, civic, religious, political, governmental, social, athletic or other activities. Do not include business/professional activities.
ORGANIZATION / DATES OF INVOLVEMENT / RESPONSIBILITIESList any significant achievements or recognition you’ve received from your community work.
How much time do you commit to volunteer per month?
In what kinds of volunteer activities would you like to become involved in the future?
If you have not had time to become actively involved, what conditions have changed now enabling you to seek involvement in the community?
GENERAL INFORMATION
What, specifically, do you hope to gain from your experience in Leadership Lake Houston?
What else would you like the selection committee to know about you?
Would you require financial assistance?Choose an item.
If yes, please include a letter requesting financial assistance. Please note availability of scholarships is not guaranteed. Scholarships granted will not exceed 50% of tuition costs.)
PROGRAM REQUIREMENTS
• Attendance is required for all sessions. Dates are tentative, but should be finalized by the opening reception. After the year begins, dates will not change unless absolutely necessary and you will be given sufficient notice. Arriving on time at the designated locations for each session is required. Time will be docked for arriving late, leaving early, or leaving during a session.
• If a bus is provided for any session, you are required to ride with the class.
• You are expected to complete any outside assignments. Information about outside assignments will be given at the Opening Reception.
• You are only allowed to miss eight (8) hours total during the Leadership Lake Houston year. Any tardy or partial days will be included in this eight (8) hour total. The only exception is thatattending the entire Opening Retreat and Class Project Day is mandatory.
• Cell phones and pagers must be turned off during session times. Phones must be on vibrate during sessions and text messaging during sessions is prohibited. Breaks will be allotted for checking messages and returning calls. In case of an emergency, Chamber staff will know how to contact class participants.
• At the end of your Leadership year, you will be strongly encouraged to engage in a volunteer commitment in the Lake Houston Area community.
• Upon acceptance into the program, tuition is due in full and is non-refundable.
COMMITMENT STATEMENT
PLEASE PRINT AND FILL IN THIS PORTION BY HAND
I have read all the above program requirements, and I agree to the following mandatory guidelines for Leadership Lake Houston. I understand that to graduate from Leadership Lake Houston, I must:
(Please initial each item to acknowledge requirement and sign below)
____ Be in attendance for the entire Opening Retreat (a two-day, one night session in September)
____Attend all sessions (exceptions are made for missing 8 hours)
____ Attend the entire class project time
____Complete outside assignments (riding with police officers, attending a school board meeting, etc.
Information will be provided at the Opening Reception)
____Use transportation provided by Leadership Lake Houston, when applicable
____Agree that any photos taken during any Leadership Lake Houston session may be used for publicity
purposes.
I have cleared my calendar to participate in the Leadership Lake Houston Program. I commit to attending the opening retreat, all sessions and the graduation ceremony. If selected, I will devote the time necessary to complete the program. Even though emergencies do arise, any participant missing more than eight hours, for whatever reason, may be asked to withdraw from the program. I realize that if I voluntarily withdraw from the program, or am asked to leave the program, my tuition will not be refunded.
______
Applicant’s SignatureDate
EMPLOYER COMMITMENT (Skip this if you are self-employed or if this is not applicable)
This application has the approval of this organization. The applicant has our full support which includes the time required to participate in the program. We also agree to pay $895 in tuition costs for this applicant to participate in the program.
______
Signature/Printed Name
______
Title
Applications are be due by May 26 at 5:00 p.m.
Selected applicants will be notified by July 6.
RETURN APPLICATION MATERIALS TO:
Johnston Farrow, Community and Membership Development Director
Lake Houston Area Chamber, 110 W. Main, Humble, TX 77338
281-446-2128 •