Class of 2023 Leadership Alamance Application

Selection Criteria

The Leadership Alamance Selection Committee seeks to identify those individuals most likely to utilize their leadership capacities in community service for the long-term benefit of Alamance County. Participants will be selected based upon the information provided in the application. A rubric will be used to assess each application on the following: adherence to instruction, completeness and depth of response, and effectiveness in written communication. Participants are selected after consideration of their leadership achievements, community involvement, overall accomplishments, recommendations, and ability to assume expanded community responsibility. Leadership Alamance requires a serious commitment of time. Participants should be prepared to devote an evening for the program social, two days for the opening retreat (both held in September) and one full day per month from September through May, as well as a day for the closing retreat (held in May) and an evening for graduation (held in June). Prior to each session, students must complete a prerequisite determined by the steering committee. Before graduation day, participants must complete a class project as determined by their classmates. Candidates must have the full support of the organization they represent. Those who are unable to make the entire time commitment should not apply. Attendance at the opening retreat held on September 8 and 9 is REQUIRED to participate in the program. A full program calendar of projected dates for the Class of 2023 can be found on the Alamance Chamber’s website. Please review the program calendar for conflicting dates prior to submitting your application.

Instructions

• Please complete each section limiting answers as specified.
• Do not include tuition payment with the application.
• Applicants requesting scholarship assistance must complete the Leadership Alamance Scholarship Request Form and submit it along with the Leadership Alamance Application.
• In addition to your application, one letter of recommendation must be submitted on your behalf to logan@alamancechamber.com.
• Applications must be signed by the applicant.
• Application and scholarship request deadline is June 24, 2022. Applicants will be notified of their status by August 1, 2022.

Personal Data

Name*

First Last

Name you prefer to be called:*

Home Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Cell Phone*

Preferred Email*

Enter Email Confirm Email

Hobbies, interests, and special talents:*

Emergency Contact Name*

Relationship*

Emergency Contact Cell Phone*

To help us ensure a safe and pleasant experience, please note any dietary needs, medical restrictions or physical limitations we need to take into consideration:*

Gender (self-identify)*

Date of Birth*

T-Shirt Size*

Are you a previous applicant?*

Yes
No

Have you participated in another community leadership program?*

Yes
No

If so, name of program:

What year did you complete the program?

Education History

Name of high school and year of graduation:*

Name of colleges/universities, year of graduation, and major:*

Employment Information

Employer*

Date of Employment*

Job Title*

Business Address*

Street Address Address Line 2 City State ZIP Code

Business Phone*

Name of Sponsor*

This is the person supporting your participation in the program (i.e. CEO, Senior Executive, or Supervising Executive) If you are a business owner or CEO, insert your name here.

Signature*

My employer understands the goals and objectives of the Leadership Alamance program and offers their full support for me to invest the time required to participate in Leadership Alamance.

Employment History*

List previous employment in reverse chronological order (include employer, position and dates):

What do you consider your highest career achievement to date?*

Community Involvement

Please list, in order of importance to you, up to five community, civic, professional, religious, political, social or other organizations in which you are or have been involved (include organization, offices held, and dates):*

Vision and Leadership

Please answer the following questions in 1000 characters or less.

What do you consider your most important accomplishment in community or civic activities? Why?*

What is your vision for Alamance County?*

In your judgement, what are the three most pressing challenges facing Alamance County today? What are your recommendations for meeting these challenges?*

As a leader, what would you like to contribute to the community?*

Why do you want to participate in Leadership Alamance and what do you hope to gain from the experience?*

How will your background, experiences, skills and assets add to the diversity of the leadership class?*

References

Please list two people, other than your sponsor, who are knowledgeable about your leadership performance and potential.

Name*

First Last

Job Title*

Employer*

Business Address*

Street Address Address Line 2 City State ZIP Code

Business Phone*

Email*

Name*

First Last

Job Title*

Employer*

Business Address*

Street Address Address Line 2 City State ZIP Code

Business Phone*

Email*

Signature*

I hereby give Leadership Alamance the right to make inquiries regarding my application and references.

Tuition

Tuition for Leadership Alamance is $950 for chamber members and $1150 for non-chamber members. Please contact the chamber office if there is any question about your chamber membership. Tuition covers all program costs including the opening and closing retreats, lunches, transportation from the program's point of origin, and graduation. Upon invoicing, payment may be made by check, MasterCard or Visa. Payment is due by August 26, 2022. If an applicant cancels within 10 business days prior to the retreat, one-half of the full tuition will be forfeited. If an applicant cancels after the retreat, the entire tuition will be forfeited. Applicants requesting a scholarship must complete a Scholarship Request Form.

Tuition will be paid by:*

Employer
Participant
Other

If you selected other, please specify:

Bill to:*

Please insert the name, business, and address for where the invoice should be sent.

First Last

Business Name*

Business Address*

Street Address Address Line 2 City State ZIP Code

COVID-19 Considerations

The safety of program participants, staff, volunteers, and community members is a top priority for the Alamance Chamber. This year's Leadership Alamance experience is planned to be held in-person. The Chamber will monitor the COVID-19 situation in the county, however, and may shift session to a hybrid format, meaning sessions may be held in-person, virtually, or a combination of both, when appropriate. Visiting sites in-person is priority and will be done whenever possible.

Commitment

To successfully complete the Leadership Alamance program, a participant is expected to attend all sessions. Absences are excused with Steering Committee approval only in the event of emergencies or extenuating circumstances. (Please note business conflicts are not considered extenuating circumstances.) Only one excused absence is allowed. A participant who is unable to attend all sessions may be asked to withdraw from the program and no portion of the tuition will be refunded. Because of the time commitment, it is important that an applicant have the full support of his/her employer to attend all sessions. I understand the goals and objectives as well as the attendance, payment and cancellation requirements of the Leadership Alamance program. I am willing to participate fully and devote the time to this program as described.

Signature*

Release Form

In consideration of agreeing to participate in the Leadership Alamance program, the Participant hereby releases the (i) Alamance Chamber (the "Chamber"), its agents, officers, servants and employees and (ii) any third parties providing facilities or work space access to the Participant while engaged in the Leadership Alamance program, from any and all liability, claims, demands, actions and causes of action whatsoever arising out of or relating to any loss, damage or injury that may be sustained by the Participant or any property of the Participant while engaged in or under the control or supervision of the Chamber during the course of the Leadership Alamance program. The Participant is duly aware of the risk and hazards inherent in participating in physical activities associated with trust and team building activities of Leadership Alamance and is also aware of the potential risk and dangers inherent in workplaces and other locations the Participant may visit during the course of the Leadership Alamance program. The Participant hereby voluntarily assumes all risk of loss, damage or injury that may be sustained by him or her or any property belonging to or in the possession of the Participant while engaged in the Leadership Alamance program. Furthermore, to the extent that negligent or reckless actions of the Participant may cause damage to the workplace or facilities of third parties assisting with the Leadership Alamance program, Participant agrees to indemnify and hold harmless Alamance Chamber from liability for such damage or injuries to third practices attributable to the negligent, reckless and/or intentional acts of the Participant.

Signature*

Photograph and Media Release

I understand that photographs and video may be taken of the participants during the course of the Leadership Alamance program. I consent to such photographing and videotaping for the use by Leadership Alamance, the Chamber and any third party program partners without compensation, of my name, image, likeness, whether in film, photographs or any other media for the promotion by the Chamber of Leadership Alamance and other activities of the Chamber.

Signature*

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2022-2023 Leadership Alamance Application

Selection Criteria

Instructions

Personal Data

Education History

Employment Information

Community Involvement

Vision and Leadership

References

Tuition

COVID-19 Considerations

Commitment

Release Form

Photograph and Media Release

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