LCC

LEADERSHIP CHEYENNE COUNTY

PROGRAM APPLICATION

2017-2018

Instructions: Please complete this form in its entirety, including all requested attachments. Complete applications must be submitted to Denise Wilkinson at the Cheyenne County Chamber of Commerce no later than July 31, 2017. Upon acceptance into the class, a bill for tuition will be sent.

Full Name / Employer
Home Address / Business Address
City / City
State/Zip / State/Zip
Home Phone / Business Phone
Cell Phone / Email Address

Emergency Contact Information:

Name / Phone Number
PROFESSIONAL RECOMMENDATION
Please include a letter of recommendation from your current/sponsoring employer(s) with this application.
SHORT ESSAYS
Please write a brief statement regarding each of the questions below. Attach a separate sheet if necessary. (Note: Please limit responses to 300 words per section.)
1.)Success & Goals:
What is your definition of success (personally & professionally).
What characteristic/trait/skill do you currently not have that you would like to acquire?
2.)Current Employment:
How would others describe working with you?
How would you proceed on a project without guidance or direction?
How do you feel or react when your ideas are questioned?
3.)Your thoughts/views on leadership:
List some common characteristics of leaders.
Give examples of timeless leadership principles.
Give some examples of individuals you feel are or have been leaders.
4.)Your own experiences with leadership:
Give examples of leadership you have demonstrated (personally & professionally).
Describe a time when you were not a leader but would have like to have been.
5.)Your community:
What issues do you see Cheyenne County facing today?
List your current volunteerism activities or future endeavors.
What is your passion issue or volunteerism area in our community?

APPLICANT’S CERTIFICATION

Commitment/Attendance: To graduate from the Leadership Cheyenne County program you must attend the September orientation session (mandatory) and you must attend a full day’s session each month. Participants can miss no more than one full day or two half day sessions in order to graduate with their current class. However, the participant may graduate the following year upon completion of the missed session(s).

Confidentiality of Information: Information contained in this application will be maintained in a confidential manner at all times. Distribution and/or reproduction of any record or information outside the intended and approved useis strictly prohibited. Illegal access or misuse of this information is punishable by fine and/or imprisonment. By signing this application form I acknowledge and agree to the above requirements.

Applicants Signature: I understand the purpose of the Leadership Cheyenne County program and, if I become a participant, I will devote the time and energy necessary to make it a successful experience. I also understand that my submission of this application does not guarantee my acceptance into the program.

Tuition is $450 per participant. This covers most of the expenses for the trip to Lincoln, some meals, snacks and the material necessary for the program.

Applicants Signature / Date:
Employer’s Signature / Date: