LEADERSHIP MONTGOMERY COUNTY APPLICATION

APPLICATION FORM - Class of 2027
The goal of Leadership Montgomery County is to identify and further develop both existing and potential community leaders, who can in the years ahead assume a dynamic leadership role in shaping the future of Montgomery County. Due to the critical importance of selecting quality candidates for the program, as well as, the desire to have each class represent a diverse cross- section of the community, a great deal of information is asked of you in this application. Please be as thorough and accurate as possible in your responses. All applications are subject to confidential evaluation. As a matter of policy, Leadership Montgomery County does not discriminate among applicants on the basis of race, religion, sex, national origin, age, or disability.

Class size is limited. If you are not selected to participate in the current Leadership Montgomery County program, your application will be retained by the committee for consideration of later enrollment. All applicants will be notified of acceptance or non-acceptance.
PERSONAL INFORMATION
Name:

First NameMiddle InitialLast Name
Home Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Years livedworked in Montgomery County:
City & State of Previous Residence:
Do You Anticipate Being a Long Term Resident?

yesnomaybe
Home Phone:
Format: (000) 000-0000.
Business Phone:
Format: (000) 000-0000.
Email Address:
example@example.com
Mens Shirt Size
Ladies Fitted Shirt Size
OPTIONAL INFORMATION
Registered Voter?

YesNo
MaleFemale
Race
Date of Birth

MonthDayYear
Date
Martial Status
Spouse's Name
Physical Restrictions:

YesNo
Explain.

Special Honors or Recognition:
Community or Civic Activities or Other Involvements:
EMPLOYMENT INFORMATION:
Current Employer
Position
Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

(In Reverse Chronological Order)

Rows	Previous Employers	Title/Responsibility	From	To
1
2
3
4

ORGANIZATIONAL AFFILIATIONS AND ACTIVITIES
Please list, in order of importance to you, up to five civic, professional, social, and religious, community, academic, athletic or other organizations of which you are or have been a member. Please note any leadership positions held.

ORGANIZATIONAL AFFILIATIONS AND ACTIVITIES

Rows	ORGANIZATION	TITLE/RESPONSIBILITY	APPROXIMATE DATES OF MEMBERSHIP
1
2
3
4
5

Special Dietary Needs:

List the three most significant problems and/or opportunities confronting Montgomery County in the years ahead, and provide us with your thoughts on how those problems/opportunities might most effectively be responded to in serving the community's best interests. Attach additional sheets if necessary.
Why are you applying for admission to Leadership Montgomery County, and how do you hope to benefit from your experience in the program?
After successfully completing Leadership Montgomery County, what degree of effort are you prepared to invest in your continued development?
What do you consider to be your major strengths? How do you think you can use this during the class?
What do you consider to be your most significant developmental needs, areas in which you would most like to improve?
What types of accomplishments tend to be the most fulfilling to you?
Have you ever been convicted of a felony or violent crime?

YESNO
If yes, please explain:

Applications must be received by Friday, May 29, 2026.
The tuition fee for the Leadership Montgomery County program is $575 per year, which may be paid by the individual or by a sponsoring company or organization.

There are limited tuition scholarships available. If interested in available scholarships, please contact the UK Cooperative Extension Office at (859) 498-8741.

Tuition fees must be paid in full by Wednesday, July 1, 2026.
Important Dates to Remember:
Orientation Session - June 30, 2026 - 6 pm (at Ext. Office Ed Cntr.)
Mandatory Retreat - July 17-19, 2026
Mandatory Final Class - April 15, 2027
Graduation - April 29, 2027 - 6 pm
Class sessions are planned for the second Thursday of each month, August thru April.
Aug-13, Sept-10, Oct-8, Nov-12, Dec-10, Jan-14, Feb-11, Mar-11, Apr-15
Class participants are required to attend three public meetings of government or organizations with which they have no affiliation. Also, each class will conduct a "class project" during the year. Class project will be determined by class members and approved by the LMC Executive Committee. One or more LMC executive committee members will serve as advisor to the class as they assess, plan, conduct & evaluate the project.

Class members are required to have a Real ID to access certain tour locations.
I hereby certify that the information provided herein, is complete and accurate. I understand that if I give false information, if I fail to attend the opening retreat, community trusteeship program or exceed the unexcused limit for absences, or if I fail to meet any part of the obligation of participating, I may be asked to withdraw from the program, without reimbursement. Class sessions are planned for the second Thursday of each month, August thru April. One absence is permitted to graduate. Other absences must be approved by the Executive Board. Additional assignments may be required. Excessive absences will result in removal from the program. I understand and accept the attendance policy as outlined.
Applicant's Signature
Date

MonthDayYear
Date
EMPLOYER COMMITMENT
Applicants for the Leadership Montgomery County program must have the support and commitment of their business or organization. To meet graduation requirements, it is necessary that participants comply with the attendance policy as outlined above. Absenteeism will result in being dropped from the course.
By checking the box below, you are confirming your employer's commitment to your participation in the Leadership Montgomery class and all of its attendance requirements.

I have my employers/supervisors support it participate in Leadership Montgomery County.
Title
Date

MonthDayYear
Date
Print Name of Supervisor
Title of Supervisor
Date

MonthDayYear
Date
Should be Empty:

APPLICATION FORM - Class of 2027

PERSONAL INFORMATION

OPTIONAL INFORMATION

EMPLOYMENT INFORMATION:

ORGANIZATIONAL AFFILIATIONS AND ACTIVITIES

EMPLOYER COMMITMENT