2021 Signature Application

Leadership Lake County has provided leadership development programs since 1987. The experiential nature of our program days and the preparation for workplace and community leadership roles are the hallmarks of our programs. The Leadership Lake County Signature Program is our flagship program, designed for established professionals in preparation for leadership service within an organization and service on non-profit boards and as community leaders. The program runs September-June for a full day on the second Wednesday of each month.

Tuition $2750 is due on August 1, 2020

Participants in Leadership Lake County, Inc. will be selected from applicants’ submissions. Please complete this form electronically. You will receive confirmation of receipt of your application within two business days.

Application Due Date: June 5 at Noon

Last Name

First Name

Name as it should appear on Nametag

Business Information

Business/Organization Name

Title/Position

Business Email

Business Phone

BUSINESS Address

Address Line 1

Address Line 2

City

Country

Select

State/Province

Select

Zip Code

Supervisor's Name/Title

Personal Information

Personal Email

Mobile Phone

HOME Address

Address Line 1

Address Line 2

City

Country

Select

State/Province

Select

Zip Code

Spouse/Partner Name

Birthdate (mm/dd/yyyy)

More About YOU

Name and City of High School

Graduation Date

Name of College

City of College

Graduation Year

Degree/Major

Name of College

City of College

Graduation Year

Degree/Major

Military Service - Branch/Dates

Civic Engagement History

Major volunteer roles at this time. Please include leadership positions where applicable.

Please list, in order of importance to you, other organizations you have volunteered for in the past.

Community Organizations/Non-Profits I am interested in serving

Employment History

Previous Employer Name/City

Dates/Title/Responsibility

Previous Employer Name/City

Dates/Title/Responsibility

Participation

In order to accomplish the program’s stated objectives, total attendance and full participation of each individual selected is necessary. Participation includes:

Mandatory attendance

Orientation - Wednesday, August 19, 2020 4:30-5:30 followed by reception with Trustees and Alumni

Opening Retreat - September 16 - 18 or 23 - 25, 2020, Punderson State Park - Wednesday Noon through Friday Noon - Overnight stay and full attendance is mandatory. Optional networking activities will be available Friday immediately following retreat.

Midyear and Closing Retreats – Full day sessions (no overnight) – Attendance is mandatory

Midyear Retreat – Wednesday, January 13, 2021

Closing Retreat and Graduation – Wednesday, June 2, 2021

One Full Day Each Month October through June – Second Wednesday of each Month

Attendance is required; a minimum of 80% attendance at these monthly sessions is required for graduation.

Wednesday, October 14, 2020 Wednesday, November 18, 2020 Wednesday, December 9, 2020 Wednesday, February 10, 2021

Wednesday, March 10, 2021 Wednesday, April 14, 2021 Wednesday, April 28, 2021 (2 dates in April) Wednesday, May 13, 2021

Time Commitment

Will you be able to fulfill this time commitment?

Employer/Family Support

Do you have the full support of your employer/family for the time required to participate effectively in this program?

Program Planning

All participants will serve on one program planning committee. Each group will have a graduate advisor. The committee has the responsibility of meeting, conceptualizing, planning, and implementing its respective monthly session. The monthly planning committee assignments will be announced at the Opening Retreat. The CEO approves the monthly programs 60 days in advance of the program date.

Please indicate below the monthly committee(s) on which you would prefer to serve, based upon your knowledge in a subject area, your contacts with decision makers, and your understanding of how decisions are made in that area(s). Every attempt will be made to accommodate you in one of your three choices.

Do NOT select committee choices within your current industry or area professional expertise.

What three (3) goals would you hope to achieve from participating in this program?

Community Issues

In your judgement, what are the two most pressing issue facing Lake County today? Explain why and provide any recommendations you may have for resolving these issues. (Approx 250 words)

Tuition

Tuition Payment

There is a tuition requirement of $2,750. per participant in the Signature Program. Tuition is due August 1, 2020. How will your tuition be paid?

Employer
Personal

Dietary Restrictions - Please note any restrictions/allergies

Referred to Program by:

Commitment

I understand the purpose of the Leadership Lake County Signature Program and that completion of this application does not ensure a candidate's acceptance into the class. If selected, I will devote the time required to fulfill all obligations to the program. By entering my name is the box below, I am approving this as an authorized signature for my application.

First Name

Last Name

Date

Thank you for your application! The Board of Trustees approves the slate of candidates at their June 2020 board meeting. Applicants will be notified of her/his status by July 1, 2020. Non-refundable tuition payment is due by August 1, 2020.

Thank you for contacting us!

We have received your application for the Class of 2020! The slate of candidates will be submitted to the Board of Trustees for approval in June. Participants selected for the Class of 2021 will be notified the week of July 1, 2020.

View Submission