2021/2022 Leadership Newton County Enrollment Application

Leadership Newton County is an eight-month program designed to educate businesses and community leaders on a wide range of critical functions in the community, such as the public safety, local history, education, state government, local government, economic development and community service. Each class is given hands on opportunities to assist local non-profit organizations through team projects which benefit the community, and ultimately provide leadership development experience.

Name

First Name Last Name

Home Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Home Phone

Cell Phone

Home E-Mail

example@example.com

Present Employer

Name

Street Address

City State / Province

Postal / Zip Code

Position Held with Current Employer

How long have you been employed there?

Business E-Mail

example@example.com

Type of Business

Business Phone

The Covington/Newton County Chamber of Commerce communicates primarily through email. On occasion there is a necessity to communicate via mail. Please indicate your preferred contact location for both email and regular mail:

Preferred E-Mail Contact

Preferred Mail Contact

Emergency Contact Name

Emergency Contact Phone Number

The sessions will be conducted monthly; primarily on the third or fourth Thursday of each month. Orientation for each new class will be in August, an overnight team building retreat will be held in September, class sessions will begin in October, and a graduation ceremony will be held in May. Each meeting will be from 8:00 AM until 5:00 PM (subject to change.) For a complete calendar of events visit the Chamber of Commerce website at www.gocovington.com/chamber/leadershipnewtoncounty.

To graduate from the Leadership Newton County program, participants are expected to attend all sessions, and conduct themselves in a professional manner. Participation in a class or team project is also required. Participants who miss more than two sessions will forfeit their membership in the class without a tuition refund. If you are unable to make this level of commitment, it is not in your best interest to apply at this time.

Tuition for Leadership Newton County Program is $795 for Chamber members, $995 for non-Chamber members. Once an applicant is selected, payment is due upon the candidate's affirmation of acceptance. Checks can be mailed or dropped off to the Covington/Newton County Chamber of Commerce, 2101 Clark Street SW, Covington GA 30014. You may contact Susan Davis, the Chamber Finance Director, for questions regarding payments at 770-786-7510.

There are limited, need-based funds available covering up to 50% of the program tuition. Applicants who would like to be considered for financial assistance should note it on their application. Your request for consideration will be held in utmost confidence and will in no way affect the selection process.

Number of years associated with Newton County

What do you hope to gain from your Leadership Newton County experience?

What skills and experiences do you feel you can bring to the class?

What organizations do you currently/previously belong to

Areas of Interests/Hobbies

Have you ever participated in a community project? If so, what?

In your opinion, what is the most pressing issue facing Newton County today?

1.Is your Company a Chamber Member?

Yes No

2. Do you have full support of your employer at this time?

Yes No

3. Do you need tuition assistance in order to participate in the LNC Program?

Yes No

Signature

Clear

Date

Applications must be received no later than close of business day on Friday, May 28, 2021 to be considered for the program.

Leadership Newton County
A program of the Covington/Newton County Chamber of Commerce
2101 Clark Street ● Covington, GA 30014 ● 770-786-7510
www.gocovington.com

Under Georgia law, there is no liability for an injury or death of an individual if such injury or death results from the inherent risks of contracting COVID-19. By submitting this application, you are agreeing to the assumption of your own risk.

LEADERSHIP NEWTON COUNTY