LT ’19 Application Worksheet
Leadership Tampa Class of 2019 Application Worksheet
This worksheet is provided to assist you with completing the Application to join Leadership Tampa’s Class of 2019. It is for your use only. This may not be attached to the application or used as a substitute. This is provided to assist you with formulating your answers. You may copy and paste any answers here into the application form.
Required fields are marked with an asterisk (*).
Candidate Name *
Nickname / Preferred Name
Home Address *
Home Phone *
Cell Phone *
Email *
How long have you lived in the Greater Tampa area? *
Optional Information
This information is helpful to ensure we meet our core value of a diverse class and environment.
Birth Date
Ethnicity
Gender
Industry
Employment Information
Current Employer *
Date of Hire *
Title *
Work Address *
Business Phone *
Extension
Education
Begin with college(s), advanced degrees and/or specialized training.
Name *
Location *
Dates of Attendance (From-To) *
Degree *
Name
Location
Dates of Attendance (From-To)
Degree
Special Awards/Honors received. (Limit 125 words).
Leadership Training
Did you attend a Leadership Tampa Information Session? (Yes/No) *
If yes, what date(s) did you attend? (Apr. 3;Apr. 12;Apr. 16;Apr. 25)
Have you completed a community leadership program in another locality? (Yes/No)*
If yes, what was the program name, location and the year of completion? (Include up to 2, starting with the most recent.)
Have you completed other leadership programs through your workplace? (Yes/No)*
If yes, what was the program name, location and the year of completion? (Include up to 2, starting with the most recent.)
Professional Accomplishments
This section provides an opportunity to share significant professional accomplishments you achieved through your employment.
Describe the leadership roles you have demonstrated within your organization. (Limit 250 words).*
What do you consider your most important professional accomplishment? (Limit 250 words). *
Greater Tampa Area Challenges & Assets
This section provides a chance for you to expand upon what you feel are the greatest strengths and opportunities for the Tampa Bay area.
What do you feel are the three most challenging issues facing the Greater Tampa area and why?
Challenge 1 (Limit 125 words). *
Challenge 2 (Limit 125 words). *
Challenge 3 (Limit 125 words). *
What do you feel are the three greatest assets of the Greater Tampa area and why?
Asset 1(Limit 125 words). *
Asset 2 (Limit 125 words).*
Asset 3 (Limit 125 words).*
Choose ONE of the issues or assets listed above and describe how you would work to solve the issue or further develop the asset. (Limit 250 words). *
Community Involvement
It is important to capture the extent of your volunteer activities outside of work, including any leadership roles and any demonstrated impact as a result of your involvement. List your current involvement in the community. These activities can include, but are not limited to, community organizations, church, children’s school or industry organizations. If you recently relocated to the Tampa Bay area, it is acceptable to list involvement from the community you most recent resided.
Organization 1 *
Position *
Dates (From-To) *
Describe Responsibility and Accomplishments (Limit 125 words). *
Organization 2 *
Position *
Dates (From-To) *
Describe Responsibility and Accomplishments (Limit 125 words). *
Organization 3 *
Position *
Dates (From-To) *
Describe Responsibility and Accomplishments (Limit 125 words). *
Choose one of the community leadership positions listed above and explain why that was your most significant community leadership position to date and the major outcomes. (Limit 250 words). *
Work Sponsors
The Leadership Tampa Rules of Conduct & Commitment must be signed by your CEO and your immediate supervisor. If you do not have an immediate supervisor, please explain. It is important your company or organization fully supports the Leadership Tampa nine-month program and is aware of your time commitment, including mandatory retreats, the absentee policy, and the financial obligation.
Work Sponsor 1 Name *
Title *
Organization *
Phone Number *
Email *
Work Sponsor 2 Name *
Title *
Company *
Phone Number *
Email *
Personal Recommendations
List two people other than your work sponsors who are knowledgeable about your leadership performance and potential. Please upload a letter of recommendation from only one of the persons listed below. Only one letter will be accepted.
Personal Recommendation 1 Name *
Title *
Company *
Phone Number *
Email *
Personal Recommendation 2 Name *
Title *
Company *
Phone Number *
Email *
Supporting Materials
Please upload a letter of recommendation from only one of the personal recommendations listed above. Only one letter will be accepted. (Letters from work sponsors may not be submitted.) *
Print, sign, scan and upload the Leadership Tampa Rules of Conduct & Commitment. *
Please upload your resume. (Limit 2 pages.) *
Upload your headshot photo (we only accept high-resolution color photos in JPG format.) *
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