Leadership Hopkinsville Class of 23-24

Leadership

Hopkinsville-Christian County

Application
A program of the

Christian County Chamber of Commerce

designed to identify and develop future community leaders.

www.leadershiphopkinsville.com

2800 Fort Campbell Blvd.

Hopkinsville, KY 42240

270-885-9096

APPLICATION DEADLINE IS THURSDAY, JUNE 1, 2023

Leadership Hopkinsville-Christian County Application
Thank you for your interest in Leadership Hopkinsville! Should you be selected for the Class of 2023-24, you will be a member of the programs 38th class and join over 600 community leaders who are Leadership Hopkinsville Alumni.

A selection commitee comprised of Leadership Hopkinsville Committee members will choose approximately 20 class members. Class selection will take place in June. You will be notified in July 2023 if you are selected or not.

Since the number of participants in the program is limited and the number of applications received far exceeds the number of selected participants, applicants who are not selected are encouraged to reapply in subsequent years.

Good Luck!
I. PERSONAL DATA
Name*

First NameLast Name
Name Tag*
Home Number

Area CodePhone Number
Cellular Number*

Area CodePhone Number
Email*
example@example.com
Personal Email (for alumni purposes)*
example@example.com
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How did you hear about Leadership?*
What is your T-Shirt Size?*
If other- please list size
Do you have any food allergies or medical food restrictions?*
If so, please indicate them here:
II. EDUCATION
List your educational background. Begin with high school and continue in chronological order with college(s) and other schools or specialized training you have attended or attained.

A.*

	School	Dates	Degree	Major
High School
College
College
College
College
Technical/Specialized
Other

B. List special awards/honors or leadership positions during school years. *
III. EMPLOYMENT
1. Current Employer*
Title*
Business E-mail Address*
example@example.com
Business Phone Number*

Area CodePhone Number
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Responsibilities*
Date of HIre*

MonthDayYear
Date
Industry*
If you are representing an organization or agency other than your employer listed above, please list the agency/organization:

2. Previous Employment

	Employer	Title	Responsibilities
Most Recent
Prior
Prior
Prior

List business / professional affiliations, positions/ assignments held and period of affiliation.*
What do you consider your highest career achievement to date?*

Leadership Hopkinsville-Christian County Application
IV. COMMUNITY INVOLVEMENT
List up to five (5) community, state, civic, religious, government, schools, social, athletic, or other organizations or activities to which you have volunteered or contributed leadership. Please include any current and/or previous community involvement.
Organization—Position/Assignment/Responsibilities—Dates-*
What have you accomplished in these activities that you consider important and why?*
How much time each month do you currently commit to volunteer work?*
If you have not been able to participant in the community in the past, what conditions have now changed that enable you to seek involvement in the community?*
Would you be willing to accept a position on a board and/or committee within the community after graduation?*

YesNo
Does your job afford you the flexibility to pursue such interest?*

YesNo
V. Tuition
A nominal tuition fee is charged for the LEADERSHIP program, which covers all your meals, activities, instructional materials used throughout the course, transportation to Frankfort for State Chamber Day. The fee is $750 for Chamber members and $800 for non-members. If a participant’s employer pays the tuition fee of $700 for Chamber members or $750 for non-members, the participant is required to pay the participant fee of $50 to demonstrate individual commitment to the program. The $50 personal fee is due upon notification of acceptance into the program. The balance is due prior to the opening retreat. No refund of tuition will be issued for any reason beyond two weeks prior to the opening retreat. A limited number of partial scholarships may be available for hardship situations.
VI. Financial Scholarship
Limited scholarship funding is available.

If accepted, will you find it necessary to seek a partial scholarship assistance towards the tuition fee? If so, how much assistance will you be seeking? Provide below a short description on why we should consider you for the scholarship.
Scholarship*
If yes, how much?
Is your acceptance contingent on receipt of scholarship funding?
If yes, provide a short description on why we should consider you for the scholarship.

Leadership Hopkinsville-Christian County Application
VII. COMMUNITY AWARENESS

Please provide a short essay to list/explain one (1) asset and three (3) areas that could be improved for the betterment of our community. (Your application will not be considered if this essay is not submitted.)
Essay*

0/1000
VIII. Participant Commitment
To graduate from Leadership Hopkinsville-Christian County Program, you, as a participant, are required to attend ALL days.

I understand the purpose of the Leadership Hopkinsville-Christian County program and if I am selected, I will devote the time and resources necessary to complete the program. I further understand that many of the class days associated with the Leadership program begin between 7:00 & 7:30 am and sometimes do not conclude until 5:00 pm.

The opening retreat is mandatory. No exceptions will be made.

I understand that if I miss one of the class days, I will not be eligible for graduation until I complete the missed day during the following class year. I understand that if I miss more than one session, for whatever reason, I will no longer be eligible for graduation from the program and no portion of the tuition shall be refunded.

I understand these commitments and agree to be bound by them in signing this application.
IX. Leadership Hopkinsville - Christian County Program Details and Schedule
Acknowledgement*

Click here to acknowledge your understanding of the attendance policy, session times, and mandatory retreat.
Browse Files

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X. Employer Commitment
This application has the approval of this organization and the application has our full support, which includes the time required to participate in the program. Please list your employer contact information below and an email will be sent to them for their approval.
Employer Contact Information*

First NameLast Name
Employer E-mail*
example@example.com
Phone Number*

Area CodePhone Number
Signature (sign by using your cursor)

Clear
Signature date
Thank you for your interest in Leadership Hopkinsville! Should you be selected for the Class of 2023-24, you will be a member of the programs 38th class and join over 600 community leaders who are Leadership Hopkinsville Alumni.

A selection commitee comprised of Leadership Hopkinsville Committee members will choose approximately 20 class members. Class selection will take place in June. Applicants will be notified of selection in June.

Since the number of participants in the program is limited and the number of applications received far exceeds the number of selected participants, applicants who are not selected are encouraged to reapply in subsequent years.

Good Luck!
Application Deadline is Thursday, June 1, 2023
Should be Empty:

Leadership Hopkinsville-Christian County Application

I. PERSONAL DATA

II. EDUCATION

III. EMPLOYMENT

Leadership Hopkinsville-Christian County Application

IV. COMMUNITY INVOLVEMENT

V. Tuition

VI. Financial Scholarship

Leadership Hopkinsville-Christian County Application

VII. COMMUNITY AWARENESS

VIII. Participant Commitment

IX. Leadership Hopkinsville - Christian County Program Details and Schedule

X. Employer Commitment