Are you ready to LEAD?
Are you ready to LEAD?
•Please type or print legibly each section in full and limit answers to available space or submit the online application that be can be found at www.clermontchamberfoundation.com/LEAD-Clermont •Attach a current professional resume
Personal Information: Name: Years in Clermont:
Date of Birth:
E-Mail: __ _______
___________________________________________________________
Home Address:
Street
Twp, Village or Municipality
City
State
Home Telephone:
Mobile:
Emergency Contact:
Name
Relationship
___ ______ Zip
Phone
PROFESSIONAL ACTIVITIES
Professional Activities:
Please list the professional activities in which you have participated during the past five years. List any awards or special recognition that you have received and indicate for each activity the nature of your participation including any offices that you have held. ______ ______ ____________
Community Involvement: What do you consider to be your most important achievement within the community? Why? What role did you play (resource, advocate, founder, etc.) in making the achievement occur? ______ ______ ________________________________________________
In your judgment, what do you see as a pressing issue or what do you see as an opportunity for Clermont County?
Statement of Purpose: How do you expect to use your personal growth from LEAD Clermont?
Professional Recommendations: Professional Recommendations. Please list two persons, other than your spouse, who are knowledgeable about your leadership performance and potential. Name: Title: Name: Title:
Phone: _____________Organization: Phone: Organization:
I, permit Clermont Chamber of Commerce Foundation to print photographs and biographical information about me in materials promoting the programs and accomplishments of its graduates. Yes Signature:
No
•Please type or print legibly each section in full and limit answers to available space or submit the online application that be can be found at www.clermontchamberfoundation.com/LEAD-Clermont •Attach a current professional resume
Personal Information: Name: Years in Clermont:
Date of Birth:
E-Mail: __ _______
___________________________________________________________
Home Address:
Street
Twp, Village or Municipality
City
State
Home Telephone:
Mobile:
Emergency Contact:
Name
Relationship
___ ______ Zip
Phone
PROFESSIONAL ACTIVITIES
Professional Activities:
Please list the professional activities in which you have participated during the past five years. List any awards or special recognition that you have received and indicate for each activity the nature of your participation including any offices that you have held. ______ ______ ____________
Community Involvement: What do you consider to be your most important achievement within the community? Why? What role did you play (resource, advocate, founder, etc.) in making the achievement occur? ______ ______ ________________________________________________
In your judgment, what do you see as a pressing issue or what do you see as an opportunity for Clermont County?
Statement of Purpose: How do you expect to use your personal growth from LEAD Clermont?
Professional Recommendations: Professional Recommendations. Please list two persons, other than your spouse, who are knowledgeable about your leadership performance and potential. Name: Title: Name: Title:
Phone: _____________Organization: Phone: Organization:
I, permit Clermont Chamber of Commerce Foundation to print photographs and biographical information about me in materials promoting the programs and accomplishments of its graduates. Yes Signature:
No
