Class of 2027 LEADERSHIP BEDFORD COUNTY APPLICATION

LEADERSHIP BEDFORD COUNTY

APPLICATION
CLASS OF 2027 (Aug. 2026-June 2027)

Leadership Bedford County, a program sponsored by the Bedford County Chamber of Commerce and Bedford County Chamber Foundation, adheres to EEOC guidelines and will not discriminate against individuals based on race, sex/orientation, age, religion, disability, national origin or socioeconomic class.
Applicant's Name

First NameLast Name
Business or Organization
Business Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Current Position/Title
Email
example@example.com
Briefly summarize your current job responsibilities.
Briefly share your education and training, including degrees, certifications and any seminars or trainings you've attended in the last 5 yrs related to management, leadership or community service.
Cell Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Home Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Community Involvement - Please list in order of importance three organizations (i.e. community, civic, professional,religious, social, athletic, etc.) of which you are or have been a member during the past five years. Please also share info about your leadership positions and/or significant contributions.
How much time each month do you commit to community, civic and other organizations and activities?
How did you become aware of Leadership Bedford County?
Why do you want to participate in Leadership Bedford County and/or what do you hope to gain from being part of the program?
Leadership Bedford County invests considerable resources toward creating a valuable program for all class participants, and a similar commitment is expected from those who apply for the program, as well as the companies/organizations they represent. Attendance during the 2-day retreat in September is absolutely mandatory. Attendance is expected during all monthly sessions from October through May, special sessions in November and April, and a visioning/graduation program in June, along with participation in a class project (details determined by the class.) Outside of extreme circumstances, no more than one absence for a monthly class is permitted to still be eligible for graduation. Persons who cannot adjust their schedules to accommodate the session days should not apply. Class members are expected to attend each session in its entirety to allow all class members to gain the most benefit possible. Are you prepared to meet the attendance requirements of LBC?
Employer support is vital to your success in Leadership Bedford County. Is your employer aware of and in approval of your application, including the program attendance requirements as outlined herein?
Full tuition ($1,500) is due prior to the retreat unless other arrangements are made. If you are selected, tuition will be paid by:
Do you need to be considered for partial financial assistance (scholarship)?
If requesting consideration of a scholarship, please share with us the reason such support is needed:
Do you prefer to be contacted:
Signature (by signing this application, I attest that all information provided is true to the best of my knowledge, including employer support for my participation in the program, if selected.)
Should be Empty:

LEADERSHIP BEDFORD COUNTY

CLASS OF 2027 (Aug. 2026-June 2027)