Leadership Premier Class of 2023 Application

Personal Information

Name*

First Last

Nickname

Birthdate*

Gender*

Ethnicity*

Year Arrived / Employed in Howard County

What year did you first arrive in or were you first employed in Howard County?

Please enter a number from 1900 to 2022.

Home Address*

Street Address City State ZIP Code

Personal Email*

Home Phone

Mobile Phone*

Employer Information

Employer*

Date of Hire (month / year)*

Type of Business

Business Phone*

Title

Work Email*

Responsibilities

Business Address*

Street Address City State ZIP Code

Business County*

Work History

Additional Employer 1

Title / Responsibility 1

Start Date 1 (month / year)

End Date 1 (month / year)

Additional Employer 2

Title / Responsibility 2

Start Date 2 (month / year)

End Date 2 (month / year)

Additional Employer 3

Title / Responsibility 3

Start Date 3 (month / year)

End Date 3 (month / year)

Education

Name / City of Institution(s)

Degree(s)

Special Honors & Awards

Community Involvement

Member Organizations*

Please list up to three civic, professional, business, religious, social, community, athletic, or other organizations of which you are or have been a member. State the name of the organization, the dates of membership, and your responsibilities.

Leadership Roles*

Please list your current volunteer leadership role(s). State the name of the organizations, your position, and describe your responsibilities for each.

Important Accomplishments*

What do you consider to be your most important accomplishment in one of your volunteer roles?

Special Honors*

What special professional or civic honors or awards have you received? Please indicate dates.

Involvement Conditions

If you have a limited history of volunteer involvement, how do you expect that to change so that you will be able to give back more after the LHC program?

Volunteer Time*

How much time each month do you commit to volunteer service?

Challenges Facing Howard County*

In 50 words or less, please briefly explain what you believe are the three most significant challenges facing Howard County.

Effecting Change*

Please select one of the challenges you've indicated above and describe in 50-100 words what measures you feel need to be taken to effect change for the better.

County Opportunities*

From your perspective, what are the three most notable strengths of Howards County? Please use 50 words or less for each strength.

What specific skills or knowledge do you hope to gain from your participation in Leadership Howard County?*

What unique perspective or experience do you feel you can contribute to this Leadership class?*

If you had one week to devote to a community service project, what would you do and why?*

References

Two references are required per candidate.

First Name (Recommendation 1)*

Last Name (Recommendation 1)*

Email (Recommendation 1)*

First Name (Recommendation 2)*

Last Name (Recommendation 2)*

Email (Recommendation 2)*

How did you learn about Leadership Howard County? Please be specific.*

Application Signature*

By submitting this application you hereby indicate that all of the provided information is your own original content and accurate to the best of your knowledge. You understand that a $75 application fee is due along with your submission and agree to be bound by Leadership Howard County's Terms & Conditions. Once you submit this form you will be directed to a checkout page where you can complete payment of the $75 application fee. Please type your name in full in the field below to indicate your acceptance and agreement and to complete your application submission.

Application Submission Date*

Please input today's date to confirm your application submission.

Leadership Premier 2023 Application