Page 1 of 3: Leadership Greater Augusta Application

How many years have you lived or worked in the Augusta region?

Employment Information

Current Employer

Employed Since:

Position Title:

Do you anticipate being transferred in the next 3 years?

Yes No

Responsibilities:

List previous positions (within 5 years, beginning with the most recent; include military duty):

Employer/Location Title/Responsibility

What do you consider your highest professional achievement?

Application Deadline: August 14, 2015

Notification of Acceptance: August 28, 2015

Use the “Tab” key to jump from one blank to the next. To answer a “yes” or “no” question, go to the correct one and click or hit the space bar. If you need more room to answer, keep typing—the area will grow.

Full Name:

Last First M.I. Dietary Restrictions/Other Accommodations?

Company name, if applicable:

Street Address Apartment/Unit #

City State Zip Code

Work Phone:

( ) ____ Mobile Phone:

( ) ___ E-mail Address:

________________________________

Education: List the education and training you consider significant:

School Name & Location Degree Awarded Major/Other Details

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How did you hear about Leadership Augusta? What is/are your reason(s) for applying? Chamber e-blast Chamber website

Newspaper LGA Alumni

Chamber Newsletter Co-worker Chamber Ambassador Other:

Learn more about the community Engage in the community to make a positive difference

Learn and practice community leadership skills All of the above Other:

Open Answer Questions: Please answer the 2 questions below in the space provided. Please heed the limits, and do

not change the formatting (font, line spacing, etc.) 1. Describe one of your professional and/or personal ambitions. Explain what you hope to achieve and the benefits of that ambition. What specific skills could Leadership Greater Augusta emphasize to help you achieve that goal? (limited to ½ page)

Volunteer Activities and Community Involvement: With what significant activities have you been involved during

the last ten years that demonstrate your commitment to your community? Include work for schools, neighborhoods, political campaigns, religious groups, cultural, athletic, professional and business activities:

Organization Date Title/Position or Responsibilities Title/Position or Responsibilities

Awards/honors:

Name Date Other Details

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2. What do you consider to be two significant challenges facing the Greater Augusta region today? Explain the significance of these issues, from your perspective. (limited to ½ page)

A recommendation form is attached. Two letters of recommendation are required. One from your employer, preferably

immediate supervisor, and one from a community source who can explain how your background and experience would contribute to the leadership class and why you should be considered.

Please complete the top half of the form with your personal information and deliver it to two (2) references, including a stamped, self-addressed envelope for them to return the recommendation form to: Leadership Greater Augusta, P.O. Box 1107, Fishersville, VA 22939 by August 14. Or email to infoadmin@augustava.com Please note: if recommendations are not received by August 14, your application will not be considered by the reviewing committee.

Applicant Agreement I understand that Leadership Greater Augusta is a community leadership training and development program, as well as a community leadership network coalition. Graduates of Leadership Greater Augusta are expected to maintain involvement in the program and to continue to participate as leaders both in the community at large and in Leadership Greater Augusta committees and programs. If selected to participate, I agree to pay in full the nonrefundable tuition, commit the time required of the program (during sessions as well as approximately 50 hours outside of sessions), and to meet the attendance and professional decorum requirements. No refund will be given after August 28, 2015.

___________________________________________________ _________________ Applicant Name, serving as signature Date

___________________________________________________ _________________ Immediate Supervisor Name, if applicable, Date

Leadership Greater Augusta Attendance Policy

Attendance at all sessions is required for successful completion of this program.

Participants who miss the Opening Retreat or Mid-Course Retreat will be suspended from the program (with no refund).

Participants are eligible for a certificate of completion if they have no more than two excused absences. Absences for reasons of work, illness, and family emergency are considered excused.

Arriving late or leaving early is considered a half-session absence (with two such events the equivalent of a full-session absence).

Submit application via email to: infoadmin@augustava.com

__________ Applicant must initial indicating they have read and understand the Attendance Policy