Leadership Paulding Application

The purpose of the Leadership Paulding program is to identify, encourage, and develop leadership abilities so that participants grow both personally and professionally. Through presentations, discussions, and work sessions, Leadership Paulding seeks to inspire those who are willing to get involved. Participants are given the opportunity to meet and interact with current community and business leaders in economic development, education, recreation, government, public safety, agritourism and many more areas. Participants are REQUIRED to participate in a 2-day retreat in September, full day (8am-5pm) sessions on the 3rd Thursdays of Oct-May, and the graduation program the first Thursday in June, 11:30am-4pm. You have been recommended to participate!

Instructions

♦ Please complete each section in full according to the directions & return. ♦ All applicants will be interviewed. LP participants will be notified the following week and be announced publicly at our GreyStone Power Luncheon the first Thursday in August. ♦ Cost of program is $1075.00. (Full payment must be received no later than September 1st)

Leadership Paulding Selection Criteria

♦ Attendance at the retreat and all monthly meetings is MANDATORY. Those who fail to attend will be asked to withdraw and will not be considered for graduation. ♦ Application to Leadership Paulding is open to persons living or working within Paulding County or the surrounding region. * Participants must be and stay a member in good standing with the Paulding Chamber of Commerce. ♦ Applicants/participants must have the full support of the organization or corporation they represent. (Individuals may nominate themselves) * No refunds will be issued if you voluntarily or are asked to withdraw from the program.

Personal Information

First Name *

Last Name *

Preferred Name (for name tags) *

Sex *

Male Female

Date of Birth *

Format: M/d/yyyy

Home Address

Address Line 1 *

Address Line 2

City *

Zip/Postal Code *

Personal email address *

Cell Phone Number *

Number of years in Paulding County *

Employment

Business Email *

Employer, Business or Organization Name *

Type of Business *

Business Phone Number *

Position, Job Title or Responsibilities *

Business Physical or Mailing Address *

Volunteer Involvement

Please share any involvement with non-profit or other charitable organizations. Be sure to describe your volunteer or leadership roles and responsibilities:

1 - Organization Name

Roles and Responsibilites

How long have you served with this organization or what time frame?

2 - Organization Name

Roles and Responsibilites

How long have you served with this organization or what time frame?

General Information

One of the goals of Leadership Paulding is to build a network of community leaders who can enhance their problem-solving and other leadership abilities through shared perspectives and working together.

A. What do you consider to be the three most significant problems facing Paulding and this region today?

1 -

2 - *

3 - *

B. What are the three most notable opportunities that Paulding County and the region have to offer people not currently living or doing business here?

1 -

2 -

3 - *

Recommendation and Support

Corporate Sponsorship from current employer: Please upload letter of recommendation and support that was received with the nomination application. This should be signed by company leadership acknowledging the commitment to time required and financial obligation.

Commitment

To graduate from Leadership Paulding, participants are expected to fulfill certain requirements and be notified of conditions that govern class participation. If you agree to adhere to these requirements and conditions, please initial each and sign statement below:

I agree to attend all sessions, including graduation, the entire full day each month, from 8:00 – 5:00 pm. (Sessions are generally held the 3rd Thursday of each month, beginning in October with graduation in June. For planning purposes, schedule changes are announced well in advance.) Those who miss more than ONE meeting will not be considered for graduation! *

Yes No

I Agree that tuition fee of $1075.00 WILL BE PAID IN FULL by September 1st. *

Yes No

I understand the requirements, commitments, and conditions of the Leadership Paulding program. If selected for the class, I agree to abide by all of the above requirements. *

Please type full name as electronic signature

Date *

Format: M/d/yyyy