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The Chamber, Gadsden and Application for Gadsden State

Etowah County LEADERSHIP ETOWAH Community College

Date: ______________________ (PLEASE TYPE OR PRINT)

Name______________________________________________Date of Birth ___________________________

Home Address_____________________________________________________________________________

Home Phone ____________________Cell Phone___________________Years in Etowah County___________

Business Name______________________________________email address:___________________________

Business Address___________________________________________________________________________

Business Phone__________________________Spouse’s Name______________________________________

Name and Age of Children___________________________________________________________________

Education

Begin with high school, then training and/or education beyond that point.

Name and City of School Dates From – To Degree/Major

_________________________________________________________________________________________

Extracurricular Activities, Special Honors for Leadership Activities, and Awards for Academic Performance:

_________________________________________________________________________________________

Employment

Account for all periods including military active duty.

Present Employer __________________________________________________________________________

Date Began ___________________ Present Title/Responsibility _____________________________________

How many days per month does your work require you to be out of the city?____________________________

Previous employment:

Employer Title From To Reason for Leaving

_________________________ ________________ _________ _________ ____________________

What do you consider your highest responsibility, skill, or career achievement so far?

_________________________________________________________________________________________

Organizations and Activities

Please list, in order of importance to you, up to five community, civic, professional, business, religious, social, athletic, and other organizations of which you have been a member.

Organization Length of Membership Office Held

_________________________________________________________________________________________

What have you accomplished in these activities that you think is important?

__________________________________________________________________________________________

Tuition and Funding

If accepted in the Leadership Etowah program, you or your employer will be billed the tuition fee of $500.00. Will your employer be paying all or part of your tuition? _________________________________________

If so, what amount? _______________________ The tuition fee covers all costs, including meals.

For those unable to pay the tuition, a limited number of scholarships may be available. Do you wish to apply for a scholarship? No _____________ Yes ____________; What amount? _______________________

General

What do you hope to gain from your Leadership Etowah experience?

_________________________________________________________________________________________

In your judgment, what are the three most pressing problems facing Etowah County today? Explain why and give any recommendations you have for approaching and resolving these problems.

_________________________________________________________________________________________

References

You may, but are not required to, list up to three references whom we may contact:

_________________________________________________________________________________________

All applications are subject to confidential evaluation. If you are not selected to participate in this Leadership Etowah series, your biographical data will be retained by the committee for consideration in later enrollment.

Signature ________________________________________________________________________________

Criteria for Selection

Class members must be residents of Etowah County. Those persons will be selected each year who are most apt to utilize their leadership ability for the long-term benefit of the community and whose inclusion in that year’s class furthers the objective of the program to bring together persons with disparate backgrounds and interests.

Persons will be favored for selection who:

1. Have demonstrated a desire to serve the community by past civic activities.

2. Are willing to seek leadership roles on public and private boards, in volunteer organizations, or in public office.

3. Are motivated to improve their skills.

4. Have potential for advancement to leadership positions in their own organizations, or are already in such positions.

5. Have an occupation that they are not likely to be relocating from the county in the immediate future.

6. Will commit to participate fully in the Leadership Etowah program, meet its attendance requirements, and as alumni continue for at least one year their involvement with the program as resource persons, program planners, Board Members, or other roles as needed.

Attendance Policy

Leadership Etowah is designed as a total experience in which a class member attends a full-day session once a month. A different topic is addressed at each session. To receive the benefits the program intends, a class member should attend all sessions. Therefore, the Leadership Etowah policy on attendance is as follows:

1. A class member should attend all monthly sessions. A class member missing more than one session without acceptable excuse will be dropped from the class, without a tuition refund, and may reapply for the next year’s class.

2. A class member missing a session must submit make-up work as directed by and to the satisfaction of the program planner and the coordinator of Leadership Etowah.

3. A class member missing two halves of a session (half = any part of a day missed) will be considered to have missed one session.

LEADERSHIP ETOWAH

________________________________________________________________________________________

Please return completed application to either:

Kerri Griffin Jennie Dobson

The Chamber, Gadsden and Etowah County Gadsden State Community College

1 Commerce Square P. O. Box 227

Gadsden, AL 35901 Gadsden, AL 35902-0227

256-543-3472 256-549-8230