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Leadership Premier Class of 2023 Application
Leadership Premier Class of 2023 Application
Karen Bryant
2022-01-17T13:30:17-05:00
Leadership Premier 2023 Application
Personal Information
Name
*
First
Last
Nickname
Birthdate
*
Date Format: MM slash DD slash YYYY
Gender
*
Female
Male
Gender Non-conforming
Prefer not to answer
Ethnicity
*
Caucasian
Hispanic/Latino
Black or African American
Asian/Pacific Islander
First Nations/Alaska Native
Mixed/Multicultural
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
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
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
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
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.
Date Format: MM slash DD slash YYYY
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