Leadership Adams Adult Program Application

Please use this form to submit your application for the Leadership Adams Institute.

Basic Selection Criteria for Leadership Adams Institute:

An important factor in selection is identifying those individuals most apt to utilize their leadership for the long-term benefit of the community.

Basic criteria for achieving this selection are:
1. Individuals with a sincere commitment, motivation, and interest in service to the community
2. Individuals who have demonstrated commitment by past community activities
3. Individuals interested in or intending to seek public office, representation on boards, commissions, or key volunteer leadership roles.
4. Individuals with potential to assume top leadership positions within their own organization and who, in turn, may play a significant role in the community
5. Individuals with the commitment to remain in Adams County for the foreseeable future
6. A cross section of participants from business, government, community services, geographic location, etc
7. Individuals who live and/or work in Adams County
8. Individuals who will make a commitment to set aside one day per month for class and additional time for project related assignments.

Question Title

* 1. Personal Information

Name *

Company

Address *

Address 2 *

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Cell Phone Number *

Question Title

* 2. What is your gender?

Female

Male

Question Title

* 3. Who is your current employer?

Question Title

* 4. What is the address where you currently work?

Question Title

* 5. What is your current job title?

Question Title

* 6. Who is your current supervisor?

Question Title

* 7. Where did you attend high school?

Question Title

* 8. What year did you graduate high school?

Question Title

* 9. Where did you attend career/post-secondary education school or college?

Question Title

* 10. What degree or certification did you receive?

Question Title

* 11. Extracurricular or Leadership Activities: List any activities that you are currently participating in or have participated in during the past five years. Also, list any special awards or honors received for these activities or related to your education and employment:

Question Title

* 12. In your perception, identify two or three challenges you see facing Adams County currently or in the near future.

Question Title

* 13. Leadership Adams represents endless opportunities for individuals who complete the program. Please share your expectations of Leadership Adams and discuss what you hope to gain from participating in the program.

In submitting this application I hereby authorize the selection committee of Leadership Adams to verify any information contained herein. Further, I understand my responsibility in committing to monthly class meeting periods and making arrangements for this commitment with my employer.

All applications are subject to confidential evaluations. If you are not selected to participate in the current class, this does not preclude you from being considered for future classes.