APPLICATION: Leadership Lawrence Signature Program

We're excited you're here!

You're one step closer to becoming a Leadership Lawrence Class of 2023-2024 Member!

Please submit the application online by close of business on Friday, July, 14, 2023 to be considered for this cohort.

Late applications will not be considered for selection.

The online application must be completed in its entirety during one session, so we recommend reviewing the application, preparing your responses to section three, and then copy/pasting your responses into the form.

Please allow yourself ample time to complete the application. Once the application is started, do not close the window until you see a successful submission notification. Closing the application window before hitting submit will clear the form. While the form is mobile device compatible, we recommend using a laptop or desktop device to complete the application.

If you need any accomodations or assistance with completing the online application, we will gladly offer our help. Please reach out to our office by emailing keeli@lawcotn.com.

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* 1. Personal Information

First Name

Last Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Cell Phone Number

Preferred Email Address

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* 2. Employment Information

Business / Org Name

Owner / Direct Report Name

Street Number and Name / P.O. Box

Address 2

City/Town

State/Province

ZIP/Postal Code

Business Phone Number

Month/Year you joined or founded your current organization

Current Title

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* 3. Emergency Info

Emergency Contact Name

Relationship

Phone Number

Please list any allergies or medical conditions we need to be aware of.

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* 4. Demographic Info

Gender

Age

Birthday

Race/ Ethnicity (if you wish to skip this question please type "prefer not to respond".

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* 5. Why have you applied for admission to Leadership Lawrence? (What do you bring to the program/ what do you hope to gain?)

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* 6. Describe an issue/opportunity facing Lawrence County that is the most important to you. What role do you play or do you intend to play in the future of this issue?

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* 7. What would you consider to be your biggest accomplishment?

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* 8. Please list in order of importance up to five community, political, civic, professional, business, religious, social, athletic, or other committee or organizations in which you have been involved.

Organization Name

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* 9. Hobbies and Special Interests

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* 10. Because there are more applicants for Leadership Lawrence than there are spaces, we must ask that participants commit to attending 100% of the year’s program. Absenteeism may result in being dropped from the program. If you are unable to make this commitment, it is not in your best interest to apply at this time.

Are you and your employer willing to make such a commitment from

Yes

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* 11. Tuition for the Leadership Lawrence program is $950. Who will be responsible for tuition payment – you or your employer?

Employer

Self