2024 Emerging Leaders Program Application

Personal Information:
Salutation*
First Name*
Middle Initial
Last Name*
Suffix
Nickname/Preferred Name*
Preferred Pronouns*
Professional Affiliation:
Organization*
Job Title*
Contact Information:
Mobile Phone*

Area CodePhone Number
Secondary Phone

Area CodePhone Number
Which phone number is provided above?*
Which is your preferred phone?*
Primary Email*
example@example.com
Additional Email*
example@example.com
What is your primary address?*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Which address is above?*
Provide a secondary address?*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Which address is above?*
What is your preferred mailing address?*
How many years have you lived in Montgomery County?*
How did you find out about Leadership Montgomery?
Please specify
Demographic Information:
Gender*

MaleFemaleNon-binary/ third genderPrefer to self-describePrefer not to answer
Birth Date*

MonthDayYear
Date
Race/ Ethnicity (optional) Leadership Montgomery seeks to reflect, cultural and ethnic diversity among its participants. Please indicate the racial/ ethnic category(ies) with which you identify.

African AmericanAsianCaucasianHispanicMiddle EasternTwo or More RacesNative American
Professional Affiliation:
Organization Category*
Please select the category that best describes your organization
Organization Industry*
Please choose the category that best describes what your organization does.
Employment History:

List previous positions, beginning with the most recent first. Include active military duty, if applicable:
Upload a resume in lieu of answering following questions regarding employment and education

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Employer
Title/Responsibility
Employer
Title/Responsibility
Employer
Title/Responsibility
Describe your current company/organization:
Describe your responsibilities at work:
If you upload your resume, please insert N/A to continue with application.
Education:

Begin with the most recent, and include high school or equivalent, college(s), and any postgraduate studies.
School Name, City & State
Degree Awarded
School Name, City & State
Degree Awarded
School Name, City & State
Degree Awarded
School Name, City & State
Degree Awarded
Special Awards/ Honors:
Presented By
Award/Honor
Year
Presented By
Award/Honor
Year
Volunteer Activities and Community Involvement:

Please list, in order of importance to you, the nonprofit, civic, professional, social, religious, athletic or other organizations in which you are or have been involved with. Note. This is an important part of the selection criteria.
Organization*
Position Held*
Hours per month

0-55-1010-1515-2020+
Organization
Current or Former Position Held
Hours per month

0-55-1010-1515-2020+
Organization
Current or Former Position Held
Hours per month

0-55-1010-1515-2020+
Organization
Current or Former Position Held
Hours per month

0-55-1010-1515-2020+
Open Ended Questions:
Why is Emerging Leaders a good fit for you at this time in your life?*
What do you hope/ expect to gain from this program?*
Please describe your leadership journey so far.*
Recommendation Letters

TWO letters of recommendations in PDF format must be submitted with your application. Reference letters should be from 1) your current supervisor (or client if self- employed) and 2) someone (non- related) who can supplement this application with firsthand experience of your leadership, character and/ or community service. NOTE: YOU WILL NOT BE ABLE TO SUBMIT YOUR APPLICATION WITHOUT UPLOADING BOTH REFERENCE LETTERS.
Reference Letter 1*

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Reference Letter 2*

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Tuition and Funding

If selected for the Emerging Leaders program, you will be billed $2900, which covers all program costs. If your tuition is being paid by a sponsoring organization, you must personally pay $290 to demonstrate your commitment. Payment plans are available upon request.
Tuition Assistance Form

Tuition assistance is considered separately from your application and has no influence or effect on the Selection Committee's evaluation of your application. All information will remain confidential. **PLEASE NOTE** You will need to download or print the form, then upload the completed form in the appropriate box below along with supporting documents.
Completed Tuition Assistance Form

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**REMINDER** You will need to download or print the form above, then upload the completed form here. Cancelof
Supporting Document 1 (i.e 1040/990)

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Supporting Document 1 (i.e 1040/990/other)

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Statement of Commitment

If selected, I agree to secure payment for the ensure nonrefundable tuition of $2,900 by Friday, August 18, 2023 and meet all the attendance requirements as outlined in the application. I understand that I am required to attend each session and meet the attendance requirements as outlined in the application information, and that missing more than 16 hours could result in dismissal from the program.
Applicant's Signature

Clear
Leadership Montgomery requires certification by submitting an electronic signature. To certify your application, confirm your signature.*

Confirm Signature

To finalize your application, please pay the Emerging Leaders application fee: *

EL application fee$65.00

$65 for first time applicants.

EL application fee $25.00

$25 for previous EL applicants.

Total $0.00

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Please verify that you are human*
Should be Empty:

Personal Information:

Professional Affiliation:

Contact Information:

Demographic Information:

Professional Affiliation:

Employment History:

Education:

Special Awards/ Honors:

Volunteer Activities and Community Involvement:

Open Ended Questions:

Recommendation Letters

Tuition and Funding

Tuition Assistance Form

Statement of Commitment