Leadership Lowcountry Candidate Application

L3: Leadership Lowcountry Lab Candidate Application
General Information

Home Contact Information
Name

First NameLast Name
Address

Street Address

Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Date of Birth

MonthDayYear
Date
VOLUNTARY DISCLOSURE OF SELF-IDENTIFICATION

The following questions are optional. It is important to Leadership Lowcountry Lab to include a diverse constituency in its programs. Your answers to the following demographic questions would greatly help gauge the success of these efforts. Choosing to or not to answer these questions will have no impact on our acceptance into the program. As a matter of policy, Leadership Lowcountry Lab does not discriminate against applicants on the basis of race, religion, gender, national origin, sexual orientation, age or physical ability. All applications are managed with strict confidence.
Gender
Are you physically or mentally disabled?

YESNOOther
What is your race or ethnicity?
What email address would you like to be contacted at? This must be an email you check daily.
example@example.com
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Emergency Contact Person
In the space provided, please tell us about any additional aspects of your background or identity that you would like to provide.
Present Employer/Occupation/Title
EMPLOYMENT DETAILS

In addition to sharing your current employer, please list your 3 most recent employers in reverse chronological order. Include active military duty.
Responsibilities
Accomplishments
Previous Employment #1
Title/Responsibility
Start/End Date
Previous Employment #2
Title/Responsibilities
Start/End Date
Previous Employment #3
Title/Responsibilities
Start/End Date
EDUCATION & AFFILIATIONS

List in reverse chronological order.
College/University #1
Location
Date From/to
Degree
College/University #2
Location
Date From/to
Degree
High School
Location
Date From/to
Other (e.g., experiential learning, internship, fellowship, internal employer certifications, etc.)
Special Awards/Honors (Community, educational and business awards and honors. Please include dates.)
Professional/Business Affiliation 1
Position
Responsibilities/Accomplishments
Professional/Business Affiliation 2
Position
Responsibilities/Accomplishments
COMMUNITY INVOLVEMENT

Do not include professional/business affiliations. Specify years of involvement.
Organization #1
Position held
Date from/to
Responsibilities/Accomplishments
Organization #2
Position held
Date from/to
Responsibilities/Accomplishments
VISION & PERSPECTIVE

One of the goals of LEADERSHIP SOUTHEAST is to build a network of community leaders who can enhance their leadership abilities through the sharing of perspectives and through working together. Respond to questions in brief essay format.
How do you define "leadership"?
Explain your interest in participating in Leadership Lowcountry.
What does “embracing inclusiveness in our community” mean to you?
What do you think are the three most significant issues facing the Region you, live, work or do business in do today?
Give your recommendations for approaching and resolving one of the issues you mentioned.
What do you think are the three most notable opportunities the Lowcountry Region has to offer?
Is there anything else you would like the selection committee to know regarding your interest and/or application?
Leadership Lowcountry Candidate Application REFERENCES

Please list two people who are knowledgeable about your leadership potential, ethics, and maturity. (Your letter of recommendation may come from one of these individuals.)
Reference #1

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Reference #2

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Partial scholarships are available and will be awarded based on need. (This will not affect your application. You will be asked to submit financial information once you are accepted into the class.) Please indicate whether you would like information on applying for a scholarship.

YesNo
Tuition will be paid by:

EmployerParticipantOther (please specify)
APPLICATION SUBMISSION

Read the information below and click "Done" to submit your application.
By submitting this application to the Leadership Southeast program, I certify that:

(i) I have completed this application without the assistance of others, and (ii) the information in this application is true, complete and not misleading. I will submit the $75 application fee. Which may be paid by credit card using the payment form or mailing a check made out to “Southeastern Chamber”. I will submit the required forms. Print, scan or email the completed signature page including, TIME COMMITMENT, EMPLOYER COMMITMENT and PARTICIPANT COMMITMENT which can be found in your email log, and one letter of recommendation to: contact@southeasternchamber.org or submitted in person at 2070 Sam Rittenberg Blvd, (STE B-272) Charleston, SC 29407 (Citadel Mall Location)
Signature

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If you would like to explore qualifications for the tuition payment plan options, please contact the office or fill out the final page of the Tuition Commitment Form sent to your email address.

My Products

LEADERSHIP LOWCOUNTRY TUITION PAYMENT This payment covers your Cohort Tuition in full. The payment does not include the inner-city trip to Raleigh, NC. It specifically includes: -Notebook -Pens -Cohort Sticky Pad -Mentor matchup -Speakers/Training -Alumni Circle Access -Networking -Graduation Prep -Emerging Leaders Gala Ticket (1) -Cocktails & Connections Mixer Access and much more.

$2,078.00

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

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L3: Leadership Lowcountry Lab Candidate Application

General Information

VOLUNTARY DISCLOSURE OF SELF-IDENTIFICATION

Emergency Contact Person

EMPLOYMENT DETAILS

EDUCATION & AFFILIATIONS

Special Awards/Honors (Community, educational and business awards and honors. Please include dates.)

COMMUNITY INVOLVEMENT

VISION & PERSPECTIVE

Leadership Lowcountry Candidate Application REFERENCES

APPLICATION SUBMISSION

By submitting this application to the Leadership Southeast program, I certify that:

If you would like to explore qualifications for the tuition payment plan options, please contact the office or fill out the final page of the Tuition Commitment Form sent to your email address.