Thank you for your interest in the Leadership Westerville Community Leadership Program! The mission of our organization is to create multi-generational, diverse leaders who serve the community through civic engagement, stewardship, and community collaboration.

The program year runs from September through May. Participants are expected to attend one full day session, 9 a.m. to 4 p.m., per month (tentative dates are listed: September 2, October 7, November 4, December 2, January 6, February 3, March 3, April 7, and May 5). In addition, participants are expected to attend Service Day: Saturday, April 24. Optional attendance at the annual MLK Breakfast Celebration on Monday, January 18.

Tuition for each participant is $950. Tuition covers course expenses which may include materials, assessments, meals, speakers, a professional headshot, and rental fees.

To be considered for the cohort, please complete the application by August 1, 2026.

Leadership Westerville does not discriminate on the basis of race, color, gender, religion, national origin, age, disability or sexual orientation in the selection of participants. Leadership Westerville will comply with the Americans with Disabilities Act and all other anti-discrimination legislation.

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* 1. First Name

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* 2. Last Name

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* 3. Home Address

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* 4. Cell Phone Number

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* 5. Work Phone Number

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* 8. Do you live in Westerville?

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* 9. Number of years living in Westerville

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* 10. Do you work in Westerville?

Employment (If Applicable)

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* 11. Current Employment Information

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* 12. Previous Employment Information

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* 13. Previous Employment Information

Please list schools/universities attended, degrees received and/or specialized training below:

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* 14. School/University #1

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* 15. School/University #2

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* 16. School/University #3

ACTIVITIES, HONORS, AND VOLUNTEER LEADERSHIP EXPERIENCE. Please list major volunteer leadership role(s) that you have held within the last three years.

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* 17. Experience #1

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* 18. Experience #2

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* 19. Experience #3

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* 20. Please list special honors, awards, or distinctions received for leadership,
academic, or professional performance and date received.

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* 21. Upload Resume (Optional)

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* 22. What do you consider to be your most important accomplishment in one of the organizations listed above? Why?

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* 23. Please list the types of community boards, civic organizations or volunteer groups with which you would like to become involved in the future.

GENERAL INFORMATION

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* 24. If you have not had the time or interest to become actively involved in the community in the past, what conditions have changed that enable you to become more involved in the community?

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* 25. What specific skills and/or knowledge do you hope to gain from your participation in Leadership Westerville?

REFERENCES
Please list three references, other than your current employer, who are knowledgeable about your leadership skills, leadership potential and/or community activities:

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* 26. Reference #1

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* 27. Reference #2

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* 28. Reference #3

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* 29. The Leadership Westerville program aims for the full participation from each class member. To ensure an effective learning environment, our class size is limited. The program year begins with the first session scheduled for Wednesday, September 2, 2026. Full participation is required during the entire session as it is the building block of the entire class and curriculum.

The program year runs from September through May. Participants are expected to attend one full day session, 9 a.m. to 4 p.m., per month. To fulfill graduation requirements, each participant may not miss more than two class sessions. If there is an emergency, and more than two sessions are missed, the program may allow the participant to complete the missed requirements and graduate the following year.

Tuition for each participant is $950. Tuition covers course expenses which may include materials, assessments, meals, speakers, a professional headshot, and rental fees. Your employer or a sponsor may pay your tuition.

EMPLOYER/SUPERVISOR SUPPORT (IF APPLICABLE)
If you have the full support of your employer/supervisor to participate in Leadership Westerville (And they are aware of the time commitment). Please list their contact information below so that we can reach out to them.

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* 30. Employer/Supervisor Information

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* 31. If accepted, who should we invoice for tuition payment?

LEADERSHIP WESTERVILLE APPLICATION AGREEMENT

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* 32. Leadership Westerville is committed to providing a quality program and will limit the class size. Applications will be reviewed to determine selected participants in the upcoming class. I understand the goals and attendance requirements of the Leadership Westerville program. If selected, I will commit the time necessary to complete the program and will pay my tuition upon acceptance. I further understand that Leadership Westerville selects participants based on a variety of considerations. Accordingly, I agree that the Leadership Westerville sponsors shall in no way be liable to me in the event I am not selected for participation in the program.

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