2023/2024 LEADERSHIP APPLICATION

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Email *

Name: Last, First, MI *

Preferred name for nametag

Employer/Organization *

Business Address *

Work Phone and Extension *

Email Address to which notices should be sent *

Sponsorship Information

Sponsored by (Organization Name) *

Choose One *

Sponsor Name *

Sponsor Phone
*

Sponsor Email *

Educational Background

List college(s), business or trade schools or other specialized training.

Educational Background

***Please list EACH school name, city, state, major and degree

EMPLOYMENT

Account for all periods, including military duty.

Present Employer: Begin date with current title/responsibility and length of time in this position *

Previous Employer (in reverse chronological order)

*Employer - Title/Responsibility - From Date - To Date

Community Involvement

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

Organization - Position Held - Dates

Briefly state any contributions or achievements in any of the above which you consider significant, and explain your role in these accomplishments. *

Professional and/or Personal Achievement

What do you consider your highest achievement, responsibility or skill to date?

References

Please List the names of two persons other than your sponsor who are knowledgeable about your leadership potential and/or community involvement and who may be contacted regarding your qualifications as a participant.

SCHOLARSHIP OPPORTUNITES

The B.J. Ray Small Business Scholarship

1. Please provide a brief statement of how important the B.J. Ray Memorial Scholarship is to your ability to participate in the John B. Gunter Community Leadership Class of 2024.

1. Please detail your current level of volunteerism within the community or your level of interest in becoming more active in the community.

The John Skelley Scholarship

1. Please provide a brief statement of how important the John Skelley Scholarship is to your ability to participate in the John B. Gunter Community Leadership Class of 2024.

1. Please detail your current level of volunteerism within the community or your level of interest in becoming more active in the community.

Candidate and Sponsor/Employer Agreement

Initial below as signature and date *

Sponsor's initial below as signature and date
*

Send me a copy of my responses.

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