Community Leadership Program Application - Class of 2022

Fostering Leadership Potential in our Community

CLP Class of 2022 Application.

We recommend that you review the application form, gather your data and saved copies of three letters of recommendation, and then proceed with the application process.

Purpose - To foster leadership potential in the community in order to ensure continued growth and development in our region.

Objectives - Encourage participants to develop the skills and access resources needed to provide the leadership to address community needs.

To enhance an understanding of the complex issues facing the communities of Clarke and Frederick Counties and the City of Winchester through:
Educational programs which broaden knowledge of the area and of the critical issues affecting this region.
Exposure to local government, education systems, businesses and non-profit organizations.
Introductions to community leaders and local decision makers.

Attendance - Mandatory attendance at each monthly session is strictly monitored and enforced. Because of the required time commitment the support of the participant’s employer is essential.

Tuition - The tuition for the 2021-22 program year is $775 for Chamber members, $975 for non-members.
A $25 non-refundable administration fee is included in the cost and required with the completed application.
Tuition may be paid by either the participant or the employer.

Limited scholarships may be available and are awarded based on need. See Scholarship Request Form button under the Application Form button.

Name

First Name *

Last Name *

Applicant email address *

Please enter email address

Business Name *

Business Address

Address Line 1 *

Address Line 2

City *

Zip/Postal Code *

Business Phone *

Title or Position *

Immediate Supervisor *

Immediate Supervisor Position *

Immediate Supervisor Phone *

Number of years working in City of Winchester/Clarke County/Frederick County *

Personal Information

This information is for Top of Virginia Regional Chamber internal use only.

Home Address

Address Line 1 *

Address Line 2

City *

Zip/Postal Code *

Number of years living in the City of Winchester, Clarke County, Frederick County? *

Education

School #1

School Name *

School Location *

Dates Attended

Degree

Major

School #2

School Name

School Location

Dates Attended

Degree

Major

School #3

School Name

School Location

Dates Attended

Degree

Major

Community/Professional Involvement

Please list in order of importance to you any community, civic, professional, business, religious, athletic, social, and any other organizations of which you have been a member.

What did you accomplish from your involvement?

If you have not been active in community affairs, what is the reason?

What community activities, other than those you have listed, would you be interested in learning more about or participating in?

In your opinion, what are two significant issues facing Winchester-Clarke County-Frederick County? Please explain. *

What is the reason that you wish to participate in the Community Leadership Program? *

Why do you think you should be selected to participate in the Community Leadership Program? *

Personal Recommendations

Please list three persons other than your employer who are knowledgeable about your leadership performance and potential. You may submit letters of recommendation.

Upload at least one letter of recommendation *

If applicable

Name of Reference #1

First Name *

Last Name *

Address of Reference #1

Address Line 1 *

Address Line 2

City *

Zip/Postal Code *

Phone for Reference #1 *

Name of Reference #2

First Name *

Last Name *

Address of Reference #2

Address Line 1 *

Address Line 2

City *

Zip/Postal Code *

Phone for Reference #2 *

Name of Reference #3

First Name *

Last Name *

Address of Reference #3

Address Line 1 *

Address Line 2

City *

Zip/Postal Code *

Phone for Reference #3 *

Financial Commitment

Employer/Organization will fund Individual will fund Scholarship desired (Please complete a Request for Scholarship form as well)

Funding may be provided by the employer/organization, individual participant, or scholarship financial assistance. A non-refundable $25.00 application fee is required with the application (an invoice will be sent to you). The balance is due upon acceptance to the program. Please check any that apply.

CLP Attendance Policy

CLP Attendance Policy Completion of the program will be determined by presence and participation in the sessions. To ensure that participants derive the greatest benefit from the program, attendance is required at all nine (9) sessions. The attendance policy allows only one (1) full day absence for any reason in order to graduate from the program. Tardiness, leaving early and half days missed will count toward missed time. A minimum of four hours attendance is required to receive half day credit for any session. There is no opportunity to make up sessions during the current program year. If a participant misses more than one class, they are encouraged to complete the current year’s program and may make up the missed sessions the following year in order to fulfill the requirements for completion of the program. A maximum of two sessions may be made up during the following program year. If more than three sessions are missed the participant will be considered dropped from the program and no refund or make-ups will be possible. In the event that you need to be absent from a session, please notify the program coordinator as soon as possible prior to the session that you plan to miss at (540) 662-4118 ext. 16, vmcallister@regionalchamber.biz or on the day of the session please text (540) 550-4422.

To graduate from the Community Leadership Program, the participant is required to comply with the program attendance policy. I understand the stated commitment and agree to comply. Please type your name and the date to agree to the attendance policy. *

Community Leadership Program Application - Class of 2022

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