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CLASS OF 2019 | APPLICATION INFORMATION LEAD Hampton Roads connects, challenges, and inspires regional leaders to serve as catalysts for a worldclass community. Participants from diverse backgrounds gain expanded knowledge of our community, develop lasting relationships and enhance skills to assume a more active and effective leadership role in addressing community needs. Due to program demand, it may take more than one application year to be selected. Your application will be reviewed in confidence by the selection committee of the LEAD Board of Trustees.

CRITERIA LEAD Hampton Roads is an issues and skills-oriented leadership development program designed to inform, motivate and increase the awareness of selected participants through interaction with community decisionmakers and behind the scenes experiences. Members are selected based on the following criteria: •

record of achievement in community activities and a desire to increase community involvement

the ability to set and attain goals as demonstrated by significant career, personal and community achievement

the commitment of necessary time and effort to complete the program

a commitment to serving the regional community

Applications are confidential. To assist in selecting a class that reflects the diversity of the community, you are asked to specify your gender, race and/or ethnicity.

Calendar & Attendance Expectations To graduate, participants are expected to attend all sessions in their entirety. The opening retreat is mandatory. In the event of an emergency, participants may miss time equal to one and one half day (excluding the retreat) during the year without jeopardizing their participation. If more than 2 sessions are missed, the participant may be asked to withdraw. Anyone who misses the opening retreat will be required to withdraw from the class and will not receive a tuition refund. Days are 8:00 am-6:00 pm, unless noted: 1. Orientation & Alumni Welcome Reception| Thursday, October 11, 2018; 4:00-7:00pm 2. Opening Retreat | October 18-19, 2018; overnight at a conference site. (Mandatory) 3. Monthly Seminars | Third Thursday of each month, November 2018 through April 2019; 8:00am-6:00pm at locations around the region 4. Enrichment Session: Trip to the General Assembly | Wednesday, January 23rd, 2018; 7:00am-6:00pm 5. Closing Retreat | May 16, 2019 (in region); 9:00am-6:00pm 6. Graduation Celebration | May 30, 2019 YOU WILL RECEIVE CONFIRMATION OF APPLICATION RECEIPT BY E-MAIL.

Application Deadline: September 21, 2018 To submit your application, please send to: LEAD Hampton Roads, 500 East Main Street, Suite 700, Norfolk, VA 23510 or by email to Alexis Epps at aepps@hrchamber.com. PHONE (757) 664-2529 ● aepps@hrchamber.com

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CLASS OF 2019 | APPLICATION TUITION:

If accepted into the program, you or your employer/sponsor will be billed for tuition of $3,300.00, which will be due prior to the opening retreat on October 18, 2018. Tuition covers all program costs, including lodging, meals, transportation, materials, and a leadership assessment. Tuition is nonrefundable in whole or part in the event you fail to complete the program due to non-attendance. Please check the appropriate box below - my tuition will be paid by:

Employer/Sponsor

ď Ż

Self

ď Ż

Limited need-based tuition assistance is available. A request must be submitted with the application. Tuition assistance requests will be reviewed after the selection process is complete and is not a factor in selection.

APPLICANT COMMITMENT: I understand the purpose of the LEAD Hampton Roads program, and if selected, I will devote the time and resources necessary to complete the program. This includes attendance at each of the 10-hour program days. Although emergencies do arise, any participant who has not met the minimum attendance requirement for whatever reason may be dropped from the program with no tuition refunded. I understand the above commitments and agree in signing this application to be bound by them (electronic signature accepted).

Applicant Signature

Date

EMPLOYER COMMITMENT: (if applicable) This application has the approval of this organization and the applicant has our full support, which includes the time required to participate in the program, and payment of the $3,300.00 tuition upon selection to the program.

Employer Signature

Employer Name (printed):

Business Name

Date

Title

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CLASS OF 2019 CONFIDENTIAL APPLICATION PERSONAL DATA: Dr. Mr. Mrs. Ms. _____________________________________________________________________________________________ Name (Last First Middle)

Preferred Name

Years in Hampton Roads

Do you expect to be living in this area in the next 5 years?

Title

Employer

Employed Since

Business Address (Street, City, State, Zip)

Business Phone

Email Address

www.

Briefly Describe Your Company/Organization:

Briefly Describe Your Responsibilities:

Type of Industry (i.e. engineering, law, education, non-profit, utility, etc.)

Home Address (Street, City, State, Zip)

Cell Phone

Home Phone

Personal Email Address

DEMOGRAPHIC INFORMATION: Lead Hampton Roads seeks to reflect racial, cultural, ethnic, and generational diversity in each class. Please indicate the racial/ethnic categories with which you identify:

__ African American __Caucasian __ Native American _ _ Asian/Pacific Islander _ _ Hispanic/Latino Gender: __Female

__Male

Other:_____________________

Age: __ under 30 __ 30-39 ; __ 40- 49; __50 -59; __ 60 or above Birthday: ___________ Month _____Day


PROFESSIONAL HISTORY:

(Do not list current employer)

Employer

Title

From - To

What do you consider your most important career achievement?

EDUCATION:

Begin with the most recent and include college(s), business or trade schools, and specialized training. School

City/State of School

From - To

Degree

Major

SPECIAL AWARDS/HONORS: (Please attach another document if you need additional space.) Award/Honor

Presented By

Date (Year)

COMMUNITY ORGANIZATIONS & ACTIVITIES: (Please attach another document if you need additional space.) List community, civic, professional, business, social, athletic, religious, or other organizations in which you have participated. Include Leadership Roles. Organization Positions Held/Honors Received Date (Year)

What do you consider your most important volunteer/civic achievement?


If you have not been active in your local community, please indicate why. Will anything change that might enable you to participate more fully? Please explain:

GENERAL:

What unique experiences or perspectives can you contribute to the LEAD Hampton Roads Class of 2019?

If selected, how would you use your LEAD Hampton Roads experience?

ISSUE ANALYSIS:

What are two issues/challenges facing Hampton Roads that you are passionate about? Explain why and offer recommendations for approaching and/or solving these challenges. Please submit an I ssue Anal ys is al ong wi th the appli cation. (Limit your response to one page.)

REFERENCES: Please list three LEAD alumni or other community leaders who could attest to your leadership capabilities. Name: Title:

Phone: Company:

Name: Title:

Phone: Company:

Name:

Title:

e-mail:

e-mail:

Phone:

Company:

e-mail:

LEAD Hampton Roads - SIGNATURE Program Application  

The SIGNATURE Program is our premier program designed for experienced leaders seeking to expand their circles of influence, their knowledge...

LEAD Hampton Roads - SIGNATURE Program Application  

The SIGNATURE Program is our premier program designed for experienced leaders seeking to expand their circles of influence, their knowledge...

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