Application for the Class of 2010

Application deadline: January 15, 2010

To apply to participate in LEAD VIRGINIA’s Class of 2010, please submit your:

 
PERSONAL AND PROFESSIONAL INFORMATION

Name:  
Title: Dr. Mr. Mrs. Ms.
First Name:   
Last Name: 
Middle/Maiden:
Home Address:  
Street:
City/County:
State:
ZIP:
Home Phone:
Cell:
Employer:
Position/Title:
Business Address:  
Street:
Suite:
City/County:
State:
ZIP:
Business Phone:
FAX:
E-mail:
Web Site:
Assistant's Name:
Assistant's Phone:
Assistant's E-mail:

Briefly describe your company/organization, including sector (public or private business,
government, education, non-profit, other profession, etc.) and type (i.e., banking, utility,
marketing, military, higher education, law, community services, etc.):

 
I live in a rural urban suburban area.
I work in a rural urban suburban area.

Age: Under 30   30-39   40-49   50-59   60 or above

Years in Virginia:

Family (spouse/children/significant):

OPTIONAL:  Please describe your race/ethnic background:

COMMUNITY AND OTHER LEADERSHIP EDUCATION

Have you completed a community leadership program or other leadership education/training?
Please list the program(s) and year(s) completed, and note your volunteer or leadership roles:

SUBMIT TWO ADDITIONAL DOCUMENTS:  These documents must be submitted as e-mail attachments to info@leadva.org.

RÉSUMÉ, CURRICULUM VITA, OR BIOGRAPHICAL SKETCH

Please submit a résumé, curriculum vita, or biographical sketch that provides your education (name and location of institution, degree/major/training, and year awarded) and career progression.  Please include community/civic service and volunteer activities, as well as other accomplishments.  Also include personal information on interests, hobbies, travels, etc., if you would like.

ISSUE DESCRIPTION

In a couple of paragraphs, please describe your personal views on the following topic:  What are the two most pressing issues/challenges facing Virginia today?  Explain why and offer recommendations for approaching and/or solving these challenges.  (suggested length of response:  no more than one-half page)

ATTENDANCE POLICY

Attendance at the April 15-17, 2010 Opening/Orientation session is mandatory.  If you have a schedule conflict that prevents you from participating on these dates, please wait until next year to apply.  Attendance at all program sessions is strongly urged.  Participants who miss more than two days will be asked to withdraw.  Please review the 2010 program session dates carefully and mark them on your calendar now.

SELECTION, TUITION, AND FUNDING

Applicants will be notified of the Selection Committee's decision on February 15, 2010.  If selected, you will be billed for $6,800 tuition, which covers program costs, overnight accommodations, and meals.  If you accept the invitation to participate in the LEAD VIRGINIA Class of 2010, the deadline for tuition payment is March 15, 2010.  After that date, LEAD VIRGINIA reserves the right to offer your place in the class to a wait-listed candidate.  Tuition is non-refundable after April 17, 2010.

Limited financial aid is available from LEAD VIRGINIA.  Scholarship requests will be reviewed after the selection process has been completed, and are not a factor in considering your application.  Awards are based on your explanation of need, the number of requests, and available funding.  The maximum award is $3,400.  Scholarship guidelines are available on the LEAD VIRGINIA website.

 
Do you request financial aid? Yes   No
If so, how much?

If yes, please submit a statement explaining your need.


PARTICIPATION/COMMITMENT

I understand the purpose of LEAD VIRGINIA and accept the policies noted above.  I also understand that completion of this application does not ensure acceptance.

Yes    No                Date:

Name of sponsor (not necessary if applicant is the CEO):


How did you hear about LEAD VIRGINIA?
Referral Name of person:
Website  
Media Name of source:
Other Please describe: