Leadership Academy Application

Leadership Academy Application
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
County
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone Number
Please enter a valid cell phone number.Format: (000) 000-0000.
Applicant biography (3-5 sentences written in third person)
To be used on website, newspaper, and media release if selected.
Briefly describe your connection to agriculture (e.g., crops, livestock, ag business)
Describe your Farm Bureau involvement and include your goals for your Farm Bureau involvement in the next 5 years
Please list organizations and/or groups you have been a member of and your leadership role in each if applicable
Why are you interested in participating in Leadership Academy? What are your expectations and goals for the program?
What is the most critical issue facing agriculture in the next five to 10 years?
January 8-9 – KearneyFebruary 5-6 – LincolnAugust 4-5 – TBDSeptember TBD – Washington, D.C.November 18-19 – Kearney
*Participants with schedule conflicts during the September DC trip can attend in March 2026.
If no, please list any conflicts you have:
Should be Empty: