2023-2024 Leadership Fort Dodge Application

Name*

First NameLast Name

Company*

Company Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

E-mail*

Cell Phone *

Area CodePhone Number

Work Phone *

Area CodePhone Number

Please list any special accommodations needed (dietary or otherwise):

Employer/Supervisor Contact*

First NameLast Name

Title*

Employer Phone*

Area CodePhone Number

Employer E-mail*

Participant: Why do you want to participate in the Leadership Fort Dodge program?*

Participant: What areas of the community are you most interested in learning about and why?*

Program Dates:

Sessions are held on the 2nd Thursday of each month, September through May. Sessions are 8 am to 5 pm. Dates for the 2023-2024 program include:

Thursday, August 31, 2023 – 8:00am-12:30pm Orientation

Thursday, September 14, 2023

Thursday, October 12, 2023

Thursday, November 9, 2023

Thursday, December 14, 2023

Thursday, January 11, 2024

Thursday, February 8, 2024

Thursday, March 14, 2024

Thursday, April 11, 2024

Thursday, May 9, 2024

Thursday, May 16, 2024 – Lunch Graduation

** Please note the attendance requirements (listed below) apply for each of these sessions.

Participant Expectations and Program Requirements:

Participants will be randomly assigned to a committee to help plan one of the Leadership sessions. Each class member is expected to be an active participant in planning this session.
Each participant is expected to attend one Fort Dodge City Council meeting or Webster County Board of Supervisors meeting.
Each participant must complete one volunteer/service activity outside of the session during the course of the program.

Attendance Requirements:

Each participant is allowed ONE absence during the duration of the program.
Participants who have more than one absences will be given the opportunity to make up the absence with an additional service project.
Any no call/no show may result in immediate removal from the program.
***If you know that you will not be able to meet this attendance requirement, please do not apply to participate**

By signing and submitting this application, I acknowledge receipt of the above attendance policy and understand what is expected of me as it relates to Leadership Fort Dodge and attendance. I also agree to pay the fee of $400 and understand that refunds will not be issued to participants who fail to meet the expectations of the program or who leave the program following the August 31 orientation.

Applications are not considered complete until both the application & $400 fee are received.

Participant Signature*

Clear

Participant Printed Name*

First NameLast Name

Employer's Signature*

Clear

Employer's Printed Name*

First NameLast Name

Company Name*

Date*

MonthDayYear