Emerging Leaders Program Application
This application can be saved and continued later via the button at the bottom of the application. The application is broken into several sections for ease of navigation; be sure to complete all required questions in each section. The final step in the application process is the submission of an application fee of $75 ($25 for repeat applicants).
Applications can be submitted at any time. Applications submitted between May 1 and August 31 may be placed on a waiting list to be considered for the next cohort beginning in September and/or consideration for the following cohort. Please check the option below to indicate if you would like to be considered for the cohort beginning in September.
Please consider my application for the cohort beginning in September
Personal & Contact Information
Salutation
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None
Mr.
Mrs.
Ms.
Mx.
Dr.
Other
First Name
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Middle Initial
Last Name
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Suffix
None
Jr.
Sr.
Phd.
EdD.
Other
Nickname/Preferred Name
Please indicate how you would prefer to be addressed (i.e., what name you prefer to have on a nametag).
Preferred Pronouns
Please indicate if/how you would like your pronouns to appear on a nametag.
What other LM programs (if any) have you participated in?
Business Leaders Impact Council
CORE
Encore
REAL Inclusion
Senior Leadership Montgomery
Other
Mobile Phone
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-
Area Code
Phone Number
Secondary Phone
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Area Code
Phone Number
What type of number is your secondary phone?
mobile
work
home
Which is your preferred phone?
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mobile
secondary
Primary Email
*
List the primary email you would like to use for Leadership Montgomery communications.
Additional Email
*
Please list a secondary email should we be unable to reach you via your primary email.
Administrative Assistant Email
If you would like an administrative assistant to be copied on all Leadership Montgomery communications, please input that email address here.
What is your primary/preferred address?
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please indicate your primary/preferred address type.
*
Home Address
Business Address
Other Address
Secondary Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please indicate your secondary address type.
Home Address
Business Address
Other Address
How many years have you lived in Montgomery County?
*
0-5
5-10
10-15
15-20
20+
I do not live in Montgomery County
How did you hear about Leadership Montgomery?
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Info Session (on-demand or in person)
Social Media
Personal Contact(s)
Website
Ad
Other
Please specify
If a person, please list a name - we'd love to thank them!
Demographic Information
Leadership Montgomery seeks to reflect the diversity of Montgomery County. We ask for demographic information from our applicants to ensure we are being inclusive and creating a sense of belonging in our program. We acknowledge that demographic categories can feel limiting, are a social construction, and do not encompass the wide range of people’s identities. The following questions are optional and your response is anonymous.
What is your gender identity? Check any that apply.
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Female
Male
Non-binary or gender non-conforming
Transgender
Not listed here (identify below)
Prefer not to answer
Birth Date
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-
Month
-
Day
Year
Date
How do you identify racially and/or ethnically? Check all that apply.
*
American Indian, Native American, Indigenous, or Alaska Native
Asian or South Asian
Black or African American
Latino/a/x/e or Hispanic
Middle Eastern, North African, West Asian (MENA/WANA)
Native Hawaiian or other Pacific Islander
White
Biracial, mixed-race, or multiethnic
Not listed here (identify below)
Prefer not to answer
Professional Affiliation & Employment History
For most applicants, this is an employer. If you are retired, please indicate your last employer, position, or field with a "retired" as your job title.
Organization/Employer
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Job Title
*
Organization Category
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Big Business (500+ Employees)
Mid-Size Business
Small Business (>50 employees)
Education
Government
Nonprofit
Other
Please select the category that best describes your organization
Organization Industry
*
Accounting
Advertising
Arts
Association
Banking
Children & Youth
Civic
Communications
Consultant
Education
Environment
Finance
Foundation
Health
Hi-tech/biotech
Human Resources
Information Technology
Insurance
Labor
Legal
Media
Professional Volunteer
Real Estate/Development
Recreation
Religious
Retail
Seniors
Service Industries
Social Services
Transportation
Utilities
Other
Please choose the category that best describes what your organization does.
How many direct reports do you have in your current position?
How many total employees do you oversee, inclusive of direct and indirect reports?
How will you share you Employment History, Education, & Awards/Recognition
*
Upload a PDF resume
Enter manually below
Upload a resume in lieu of answering following questions regarding employment and education
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Upload a resume in lieu of answering following questions regarding employment and education
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Employment History, Education, & Awards/Recognition
Employment History
List previous positions, beginning with the most recent first. Include active military duty, if applicable:
Employer 1
Title/Responsibility 1
Employer 2
Title/Responsibility 2
Employer 3
Title/Responsibility 3
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 1
Degree Awarded 1
School Name, City & State 2
Degree Awarded 2
School Name, City & State 3
Degree Awarded 3
Special Awards/ Honors
Presented By 1
Award/Honor 1
Year 1
Presented By 2
Award/Honor 2
Year 2
Volunteer Activities & Community Involvement
Please list the community services/nonprofit, civic, professional, social, religious, athletic or other organizations in which you are or have been involved with in the last five years. Note. This is an important part of the selection criteria.
Organization 1
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Position Held 1
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Hours per month 1
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0-5
5-10
10-15
15-20
20+
Dates of service and key accomplishments 1
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Organization 2
Position Held 2
Hours per month 2
0-5
5-10
10-15
15-20
20+
Dates of service and key accomplishments 2
Organization 3
Position Held 3
Hours per month 3
0-5
5-10
10-15
15-20
20+
Dates of service and key accomplishments 3
Organization 4
Position Held 4
Hours per month 4
0-5
5-10
10-15
15-20
20+
Dates of service and key accomplishments 4
Of those listed, which is most important to you? How have you used your leadership skills to effect positive change?
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Open Ended Questions
What inspired you to pursue this program, and how do you hope it will help you grow as a leader?
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What leadership roles do you envision for yourself in the next 5–10 years, and what steps are you currently taking to prepare for them?
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Describe a situation where you successfully contributed to a team or project. How did you demonstrate leadership in this role, and what did you learn?
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Reflect on a challenging leadership experience you’ve faced. What did you learn from this experience, and how would you approach it differently in the future?
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Upload Letters of Recommendation
TWO letters of recommendation must be submitted via PDF upload below. Letters of recommendation are an important part of the selection process and must cite specific attributes of the candidate. Letters of recommendation should be from 1) your current supervisor, indicating their full support of your participation, including recognition of the time commitment and the financial obligation of tuition; and 2) one non-related individual who can supplement the application with firsthand knowledge of your leadership, character, and/or community service. The second letter should include the nature and duration of the relationship between the writer and the candidate.
Reference Letter 1
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Reference Letter 2
*
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Reference Letter 1
*
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Reference Letter 2
*
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Tuition and Funding
Tuition for participants accepted to Leadership Montgomery's Emerging Leaders program is $3,200, billable upon acceptance into the program. Participants whose participation is sponsored by an employer or other organization are required to contribute 10% of the tuition ($320) as a demonstration of personal commitment. Payment plans and tuition assistance are available upon request.
Tuition Options (check all that apply)
Bill 90% of tuition to sponsoring organization (specify below) and 10% to applicant
Bill 100% of tuition to applicant
Payment plan requested (LM will follow up with payment plan options)
Tuition assistance requested (application below)
Sponsoring Organization
Tuition Assistance
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. Tuition assistance requests must be submitted at the time of application. All information will remain confidential. **PLEASE NOTE** You must download or print the form, then upload the completed form and supporting documents in PDF format using the upload functions below.
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.
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Supporting Document 1 (i.e 1040/990)
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Supporting Document 2 (i.e 1040/990/other)
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Statement of Commitment
If selected to participate in an Emerging Leaders Class, I agree to secure payment or payment plan contract for the entire nonrefundable tuition of $3,200 by July 15th prior to the program start date. I understand that I am required to attend each session and meet the attendance requirements as outlined in the program description, and that missing more than 11 hours could result in dismissal from the program.
Applicant's Signature
Leadership Montgomery requires certification by submitting an electronic signature.
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Confirm Signature
Full Name
*
Please verify that you are human
*
Save or Continue to Pay Application Fee
You may save and continue your application via the save button below.
NOTE: Incomplete applications are deleted after 60 days. All required fields (marked with a red asterisk*) must be completed before moving on the the application fee; this includes the two required letters of recommendation. The application fee must be paid to complete your application.
Save
Pay Application Fee
Having trouble proceeding? Try saving your documents to your desktop and uploading them from there, as cloud-based uploads may cause issues.
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