APPLICATION Submit By Email
Leadership Lake Houston is a program of the Lake Houston Area Chamber of Commerce which identifies and develops future leaders for our community. The intent of the program is to develop new community leaders and enhance the skills and community awareness of existing community leaders by exposing participants to the challenges and opportunities in various segments of the Lake Houston Area. The goal of this process is to assemble a network of community leaders who can enhance their problem solving and other leadership abilities through shared perspectives and working together. 2013-2014 Class Schedule (8:30 am - 4 pm) DATE SESSION August 27 Opening Reception (5:30 pm) September 19 & 20 Opening Retreat October 8 Social Services November 12 Quality of Life & History December 10 Government January 14 Healthcare February 11 Education March 4 Business and Economic Development April 8 Justice and Public Safety May 13 Community Leadership/Graduation APPLICANT NAME: _______________________________________________________________________ SPONSORED OR REFERRED BY: ____________________________________________________________ TUITION: $795 If received by 8/13/13. Late fee of $50 will be assessed on 8/14/13. APPLICATION CHECKLIST (Deadline to submit all materials is 5 pm, June 3, 2013):
Four copies of completed application Non-refundable $25 application fee. (Application fee is waived for Chamber members who are at or above the Gold Distinguished Investor level).
Three References
IMPORTANT DATES: June 3: Application Deadline June 24: Applicant Acceptance Notification
August 13: Tuition Deadline August 27: Opening Reception
CONFIDENTIAL APPLICATION FOR APPOINTMENT LEADERSHIP LAKE HOUSTON 2012-2013
A program of the Lake Houston Area Chamber
PERSONAL DATA
DATE________________
APPLICANT NAME: Mr. Mrs. Ms. Dr._______________________________________________________ FIRST NAME OR PREFERRED NICKNAME_________________________
MALE
FEMALE
COMPANY NAME________________________________________________________________________ BUSINESS MAILING ADDRESS_______________________________________ZIP CODE_______________ BUSINESS PHONE_________________________________ CELL PHONE____________________________ EMAIL_____________________________________________________FAX #_________________________ HOME ADDRESS___________________________________________________ZIP CODE_______________ HOME PHONE____________________________________ EMERGENCY CONTACT____________________________CELL PHONE____________________________ AGE RANGE:
20 - 25
26 - 35
36 - 45
46 - 55
56 - 65
66+
LENGTH OF RESIDENCY IN THE LAKE HOUSTON AREA________________________________________ HOBBIES:_________________________________________________________________________________ __________________________________________________________________________________________ Other personal information you’d like to share:
EMPLOYMENT INFO PRESENT EMPLOYER__________________________________________ SERVICE DATE________________ TYPE OF ORGANIZATION___________________________________________________________________ CURRENT TITLE____________________________________________________ SINCE__________________ RESPONSIBILITIES__________________________________________________________________________ __________________________________________________________________________________________ LIST PREVIOUS EMPLOYMENT IN REVERSE CHRONOLOGICAL ORDER: EMPLOYER
TITLE/RESPONSIBILITY
DATES: (FROM - T0)
BUSINESS/PROFESSIONAL AFFILIATIONS (Not including civic organizations or political activitiy): NAME OF GROUP
POSITION HELD
PERIOD OF AFFILIATION
Briefly describe your tenure in your chosen field. Note years of service and describe growth of responsiblitiy.
What do you consider your highest career achievement to date?
EDUCATION SCHOOL NAME & LOCATION
DATES ATTENDED
MAJOR
DEGREE
Other certifications or training programs:
COMMUNITY INVOLVEMENT Include community, civic, religious, political, governmental, social, athletic or other acvtivities. Do not include business/professional activities. ORGANIZATION
DATES OF INVOLVEMENT RESPONSIBILITIES
List any significant acheivements or recognition you’ve received from your community work.
HOW MUCH TIME DO YOU COMMIT TO VOLUNTEER PER MONTH?_____________________________ In what kinds of volunteer activities would you like to become involved in the future?
If you have not had time to become actively involved, what conditions have changed now enabling you to seek involvement in the community?
GENERAL INFORMATION What, specifically, do you hope to gain from your involvement in Leadership Lake Houston?
What is the most significant challenge facing our community today?
What do you feel needs to be done to resolve one of these issues?
What are the three most notable opportunities in the Lake Houston Area? 1.______________________________________________________________________________________ 2.______________________________________________________________________________________ 3..______________________________________________________________________________________ What do you feel needs to be done to develop one of these opportunities?
What other things would you like the selection committee to know about you?
Would you require financial assistance? If yes, please explain.
Submit By Email
COMMITMENT STATEMENT
I agree to the following mandatory guidelines for Leadership Lake Houston. I understand that to graduate from Leadership Lake Houston, I must: (Please initial each item to acknowledge requirement and sign below)
____ Be in attendance for the entire Opening Retreat (a two-day, one night session in September) ____ Attend all sessions (exceptions are made for missing 8 hours) ____ Complete outside assignments (riding with police officers, attending a school board meeting, etc. Information will be provided at the Opening Reception) ____ Use the transportation provided by Leadership Lake Houston, when applicable ____ Agree that any photos taken during any Leadership Lake Houston session may be used for publicity purposes. I have cleared my calendar to participate in the Leadership Lake Houston Program. I commit to attending the opening retreat, all sessions and the graduation ceremony. If selected, I will devote the time necessary to complete the program. Even though emergencies do arise, any particpant missing more than eight hours, for whatever reason, may be asked to withdraw from the program. I realize that if I voluntarily withdraw from the program, or am asked to leave the program, my tuition will not be refunded. __________________________________________________________________________________________ Applicant’s Signature Date EMPLOYER COMMITMENT (Skip this if you are self employed or if this is non applicable) This application has the approval of this organization. The applicant has our full support which includes the time required to participate in the program. We also agree to pay $795 in tuition costs for this applicant to particpate in the program. ______________________________________________________________________________________ Signature/Printed Name ______________________________________________________________________________________ Title Applications are be due by June 3 at 5:00 p.m. Selected applicants will be notified by July 11. RETURN APPLICATION MATERIALS TO: Jenna Armstrong, Chief Operations Officer Lake Houston Area Chamber, 110 W. Main, Humble, Tx 77338 281-446-2128 • jarmstrong@lakehouston.org
REQUIREMENTS (Applicants, please keep this page) • Attendance is required for all sessions. Dates are tentative, but should be finalized by the opening reception. After the year begins, dates will not change unless absolutely necessary, and you will be given ample notice. Arriving on time at the designated locations for each session is required. Time will be docked for arriving late, leaving early, or leaving during a session. • If a bus is provided for any session, you are required to ride with the class. • You are expected to complete any outside assigments. Information about outside assignments will be given at the Opening Reception. • You are only allowed to miss eight (8) hours total during the Leadership Lake Houston year. Any tardy or partial days will be included in this eight (8) hour total. The only exception is that attending the entire Opening Retreat is mandatory. • Cell phones and pagers must be turned off during session times. Phones must be on vibrate during sessions and text messaging during sessions is prohibited. Breaks will be allotted for checking messages and returning calls. In case of an emergency, Chamber staff will know how to contact class participants. • At the end of your leadership year, you will be strongly encouraged to enagage in a volunteer commitment in the Lake Houston Area community. • Upon acceptance into the program, tuition is due in full and is non-refundable. Financial Assitance: If you require financial assistance, a letter explaining your request must be included with your application. Limited scholarships may be available.