Leadership Livingston Application

Leadership Livingston 2024-2025

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Leadership Livingston 2024-2025

Program Application

Leadership Livingston runs annually from October through May and is designed to develop civic-minded community leaders in the Greater Livingston region. Upon completing the program, participants will have a deeper understanding of how community institutions contribute to the region's overall quality of life. Participants will also receive content on a wide variety of topics to enhance their leadership skills. The sponsoring organization, the participating individual and the community will benefit greatly from participation in this program.

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First Name:

Last Name: *

Cell Phone: *

Personal Email: *

Home Address: *

City: *

State: *

Postal Code: *

How long have you lived/worked in Livingston County? *

Gender: *

Age: *

Under 25

25-35

36-50

50 & Over

Employment Information- Position Title: *

Organization: *

Work Email: *

Work Phone: *

Work Address: *

City: *

State: *

Postal Code: *

Employed Since: *

Community Connections- Please list your current or past involvement, if any, in professional organizations, business and community board service and volunteerism. (Include: name of group, positions held and periods of service) *

Short Essay (1,000 words or less)- Please provide a short essay describing your motivation for participation in Leadership Livingston. Your essay could include a story about your past leadership experiences; your thoughts about the impact of effective leadership on an organization or the community; the leadership qualities you have and want to develop; and what you hope to gain from participation in this program. *

References- Please provide the names of 3 references. Include their name, title, employer, Email address, and phone number. *

Acknowledgements: *

I have discussed with my employer my intention to participate in the Leadership Livingston program and I have held these dates on my calendar.

I understand that my attendance at ALL scheduled Leadership Livingston sessions is mandatory because my participation is essential to the program's success. I have received permission to be absent from work one full day each month to attend the Leadership Livingston Sessions.

I have also discussed with my employer the importance of my participation in each session and that absence could result in my dismissal from the Leadership Livingston Program without a refund.

If for some reason I must withdraw from Leadership Livingston, notification must be given two weeks prior to the first class. If notification is given later than two weeks prior to the start date, a $500 fee will be assessed.

Required

Printed Name: *

Signature & Date: *

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