Leadership Maryland

EXECUTIVE PROGRAM CLASS OF 2025 APPLICATION

Deadline: Thursday, October 31, 2024
Important Application Instructions:

Please Read Carefully Before Proceeding
- Save Your Work: At the end of the application form, be sure to click the SAVE button often and before you submit to secure your progress. Your application will be saved for 30 days, allowing you to continue your work as long as you use the exact same computer or device. You will be prompted to create a free JotForm account to save your work. We recommend creating this account for the best experience.
- Autofill Caution: Avoid using autofill on this form, as it may cause unintended overwriting of other fields. We recommend manually entering your information to ensure accuracy.
- Review Before Submitting: Before final submission, carefully review all fields to ensure accuracy and completeness. This step is crucial to ensure your application is properly processed. Email info@leadershipmd.org for assistance.
Name*

First NameMiddle NameLast NameSuffix
Preferred Name*
Preferred Pronouns
ex. she/her/hers
Primary Email Address for all Leadership Maryland correspondence*
Years in Maryland*
Birth Date mm/dd/yyyy*
DEMOGRAPHIC INFORMATION Leadership Maryland seeks to reflect racial, cultural and ethnic diversity in each class. Please indicate the racial category with which you identify: Choose One:*

American Indian/Alaskan NativeAsianBlack/African AmericanHispanic/LatinoNative Hawaiian/Pacific IslanderWhiteOther
Gender*

MaleFemalePrefer Not to Answer
Are there additional characteristics (ex. gender, ethnicity, cultural, etc.) that define you as an individual that you would like us to consider? If YES, please explain below or simply note 'None'.*
Home Address*

Street Address

Street Address Line 2

CityState

Zip Code
County*
Please select the County in which you LIVE
Personal Email *
Home Phone*
Cell Phone*
Emergency Contact: (Name - Relationship - Phone)*
How did you learn about Leadership Maryland?*

LMD MemberLMD WebsiteProfessional ColleagueLocal Leadership ProgramSocial MediaOther
Please attach a high quality headshot *

Professional head/shoulder photo. .jpg preferred
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Employer Name*
Job Title*
Employed Since*
Number of Employees You Supervise*
Business Address*

Street Address

Street Address Line 2

CityState

Zip Code
County*
Please select the County in which you WORK
Business Website
www.example.com
Business Email*
Business Phone*
Please indicate your preferred billing address*

Home AddressBusiness AddressOther
Briefly Describe Your Company/Organization*

0/135
Briefly Describe Your Responsibilities*

0/135
Type of Industry (i.e. engineering, law, education, non-profit, utility, consulting)*
Official Authorization Statement

Upload a letter containing the following statement, along with pertinent contract information, duly signed by your CEO/Supervisor:

Statement: "I fully support the participation of this candidate in Leadership Maryland. I acknowledge the associated time commitment and financial obligation."

The letter must include the following details:
1. CEO/Supervisor Name
2. Title
3. Company
4. Phone
5. Email
6. Signature
7. Date
Official Authorization Statement*

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PROFESSIONAL HISTORY

Do not list current employer; enter "None" if applicable
Employer - Title - From/To Date*
Employer - Title - From/To Date*
Employer - Title - From/To Date*
EDUCATION

Begin with high school. Include college(s), business or trade schools, and specialized training.
School City & State From-To Degree/ Major*
School City & State From-To Degree/ Major*
School City & State From-To Degree/ Major*
School City & State From-To Degree/ Major*
List extracurricular activities in college. If none, please enter "none." *
VOLUNTEER

The Selection Committee places great emphasis on the time you commit to volunteer activities. In order of importance to you, list up to 4 volunteer community, civic, professional, business, social, athletic, religious, or other organizations in which you have been or are currently active in, and state if you held or currently hold a leadership position. (limit 75 characters per line)
Organization From-To Leadership Position Held
Organization From-To Leadership Position Held
Organization From-To Leadership Position Held
Organization From-To Leadership Position Held
SPECIAL AWARDS AND HONORS

List special awards and/or honors received (limit 75 characters per line)
Award/Honor Year Received
Award/Honor Year Received
PREVIOUS LEADERSHIP PROGRAM EXPERIENCE
If you are a graduate of a county or regional program, list program(s) and the year completed. Do NOT list work-related/military leadership programs.
List your current hobbies and interests outside of your job. (limit 135 characters)*
SHORT ANSWER & ESSAY QUESTIONS
What do you consider your highest responsibility or career achievement thus far?*

Word count 25 minimum - 50 maximum0/50
Share a time when you engaged with a volunteer organization, what talents or gifts did you share with the organization and what was the impact? *

Word count 50 minimum - 100 maximum0/100
If selected, what strengths and skills will you bring to the program?*

Word count 25 minimum - 50 maximum0/50
How would you use your Leadership Maryland experience for the long-term benefit of Maryland?*

Word count 50 minimum - 100 maximum0/100
If selected, what do you hope to gain from your Leadership Maryland experience? *

Word count 50 minimum - 100 maximum0/100
The Selection Committee places great emphasis on your thoroughness in answering this question. There are no wrong answers. In your opinion, what are the TWO most pressing issues/problems facing Maryland today? Explain why and list any recommendations you may have for solving these issues.*

Word count 300 minimum - 600 maximum0/600
References

Please list two (2) references below. Attach a letter of recommendation for ONE of these two references.
Reference*
Reference*
Recommendation Letter*

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Tuition

If selected, you will be invoiced for tuition, which covers all program expenses, except your overnight accommodations and personal transportation costs getting to and from the program location.

Tuition is $8,750, when paid-in-full by check or $8,750 when paid-in-full by credit card by March 1, 2025 (postmarked). If paid after March 1, 2025 tuition is $8,750 if paying by check and $9100 if playing by credit card. Late payment must be paid-in-full by check or Visa or MasterCard by April 1, 2025 (postmarked). A payment plan may be arranged; however, the higher tuition amount of $8,750 will apply.

Limited financial aid is available. To apply, request a Financial Aid Request Form by emailing info@leadershipmd.org. The form must be completed, signed, scanned, and attached to this application. If applying for financial aid, proof of income is required to be submitted with the Financial Aid Request form. You may scan and attach either a W-2, a K-1 from your company or Schedule C-Form 1040, if self-employed. Additional information may be requested.

Awards are based on the applicant's compelling statement of need, the number of requests received, and the amount of available funds. Applicants may request up to $5,000. However, requesting aid does not guarantee you will receive all or any of the amount requested.
Are you requesting Financial Aid?*

YesNo
If yes, how much?*
Max $5,000
Financial Aid Request Form*

Attach your completed Financial Aid Form
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Proof of Income*

Attach either a W-2 OR a K-1 from your company OR a Schedule C from Form 1040
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APPLICATION FEE

The early-bird application fee for submissions received by 5 p.m. on Tuesday, October 15th is $200. The fee is $400 for applications submitted after this deadline. The fee is non-refundable. You may pay by VISA or MasterCard (no other cards accepted) or by check made payable to Leadership Maryland, PO Box 2442, Easton, MD 21601. Please indicate your payment method. When you click SUBMIT at the end of this application, if selected, your credit card will be charged for the Application Fee. If you opt to pay by check, please mail your check to Leadership Maryland, PO Box 2442, Easton, MD 21601. NOTE: YOUR APPLICATION IS NOT COMPLETE UNTIL THE APPLICATION FEE IS RECEIVED.
How would you like to make payment?*

Credit CardCheck

My Products*

Executive Program Application FeeVisa or Mastercard only. Thank you!

$200.00

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

Check*

Check $200
Application Instructions

The deadline is THURSDAY, OCTOBER 31, 2024. Late or incomplete applications will not be considered.

Be sure you have:
1. Attached a professional color photo
2. Attached signed Authorizing Official Statement
3. Attached one Letter of Recommendation
4. Attached Financial Aid Request Form and proof of income
5. Checked your Application Fee payment method
When you click SUBMIT at the end of this application, if selected, your credit card will be charged the Application Fee. If you opt to pay by check, please mail your check to Leadership Maryland, PO Box 2442, Easton, MD 21601. NOTE: YOUR APPLICATION IS NOT COMPLETE UNTIL THE APPLICATION FEE IS RECEIVED.

You will receive an email confirmation that your application has been received, as well as a copy of your application. You will also receive a separate email with a receipt for your application fee payment.

Leadership Maryland

PO Box 2442 Easton, MD 21601 (410) 841-2101
Questions: info@leadershipmd.org
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EXECUTIVE PROGRAM CLASS OF 2025 APPLICATION

PROFESSIONAL HISTORY

EDUCATION

VOLUNTEER

SPECIAL AWARDS AND HONORS

SHORT ANSWER & ESSAY QUESTIONS

Tuition

APPLICATION FEE