2026 Leadership Beaver County Application

Education

Begin with college(s), business/trade schools or other specialized programs
Name of Institution
Graduation Date
Major
Degree
Website

Previous Employment

Include past employment history if you have worked for your current employer for five years or less.
Employer Name
Title or Responsibility

Business or Professional Affiliations (if applicable)

Do not include civic organizations, public offices or political activities.
Name of Group
Position or Assignment Held
Are you currently an active member?

Community Involvement

Include what you consider to be your most significant community, state, civic, religious, political or other activities. Do not include business or professional activities (previous section).
Community Organization
Position or Assignment Held
What are (were) your community involvement responsibilities?

Short Answer Questions
What motivated you to apply for participation in Leadership Beaver County and what do you hope to gain from the program? *
What specific skills or knowledge do you hope to contribute to the Leadership Beaver County program?*
What is one aspect of Beaver County that you would most like to have an impact on and why?*

References

Please list names and addresses of two people knowledgeable about your leadership performance and potential, and who may be contacted regarding your qualifications as a participant in Leadership Beaver County.
Name*

First NameLast Name
Business*
Title*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Name*

First NameLast Name
Business*
Title*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.

Tuition
The tuition for Leadership Beaver is $1,500 plus a $50 processing fee. If accepted into the Leadership Beaver Program, you (or your employer) will be invoiced for the tuition. The fee covers costs for all required program events and is non-refundable. Please sign your initials to show you understand, if accepted, you will be invoiced accordingly and expected to pay in full prior to the start of the program or forfeit your seat in the program.*

Employer Commitment

This application has the approval and full support of your employer, including the time required to participate in the program. Please note that repeated absences during the program will result in the Program Director contacting your supervisor.
Supervisor's Name*

First NameLast Name
Supervisor's Title*
Supervisor's Email*
example@example.com
Supervisor's Phone Number*
Please enter a valid phone number.

Leadership Beaver County Commitment
The Leadership Beaver County program consists of ten sessions. Sessions will be on the third Thursday of every month, unless otherwise stated.

The amount, quality, and value of information presented at each session cannot be overemphasized. With that said, participants are allowed to miss one session during the program. Please be aware of the attendance policy and understand the weight of your commitment to the program, with the expectation being that participants will miss no more than one session.

I understand the purpose and objective of the Leadership Beaver County program and, if selected to participate, will devote the necessary time and energy to attend each session. I understand my commitment and, in completing this application, agree to be bound by them. As noted above, I have the support and approval of my employer to attend every session of this program.
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Personal Information