LEADERSHIP MON CLASS OF 2023
PERSONAL INFORMATION
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name
*
First Name
Last Name
Birthday
*
-
Month
-
Day
Year
Date
Email
*
example@example.com
Please upload a current, head shot
Browse Files
Please make sure that this photo is professional, as it will be used on the Leadership Mon website.
Cancel
of
EMPLOYMENT HISTORY
Current Employer
*
Employer Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Employer Phone Number
*
-
Area Code
Phone Number
Position
*
COMMUNITY ACTIVITIES & INVOLVEMENT
Responsibilities & Accomplishments
*
Community & Volunteer Activities
*
Please list all organizations you are CURRENTLY involved with and a brief description of your involvement,
Awards / Honors Etc.
*
Please include any awards, honors, or certifications you have received - both professionally and personally
Hobbies & Interests
*
Please list all of your current hobbies and interests.
EDUCATION
High School
*
Please list school and year completed
Trade / Vocational School
*
Please list school and year completed
College
*
Please list school and year completed
Higher Education
*
Please list school and year completed
REFERENCES
Reference Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Is this person a graduate of Leadership Mon?
*
YES
NO
Reference Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Is this person a graduate of Leadership Mon?
*
YES
NO
QUESTIONNAIRE
What motivated you to apply for Leadership Mon?
*
What area of civic affairs would you like to become more involved in? Why are you interested in this area? How would Leadership Mon assist you in accomplishing this?
*
Please make sure to address all parts of the question,
Who would you consider your mentor and why?
*
What do you consider your most significant career achievement? Why?
*
What are the top 5 things on your bucket list?
*
Identify a particular issue, opportunity, or problem that you consider to be important to Mon or Preston County. Why is this issue important to you? How would you "fix" this particular issue? How could Leadership Mon help you in making this possible?
*
Please make sure to address all parts of the question.
APPLICATION INFORMATION
Would you like to schedule a one to one phone call to review your application?
*
YES
NO
If yes, we will contact you via phone or email to set up a date and time.
Who will be paying for your tuition
*
Employer
Self
Other
Would you like to be considered for a scholarship?
*
YES
NO
If yes, please explain why:
*
Do you have any dietary restrictions
*
Signature
Submit
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