Hancock Leadership Confidential Application

Selection will be based on:

Quality of response on the application
Meeting the deadline for the application: The application must be received at the Chamber on or before June 30, 2020.
An interview upon request of the Selection Committee.

Form Instructions:

This form does not save your information if you leave it. Please have all your information ready in order to fill out the form.
Please assume all fields are required. If you have no information for that field, please enter Not Applicable.
Once you submit the form, you will not be able to go back and change items. Again, please have information ready before submitting.

Hancock Leadership Class of 2021 Application

Personal
Applicant Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Personal Email*
Employment
Past Length of Residence/Employment in Hancock County:*
Future Length of Residence/Employment in Hancock County:*
Current Employer*
Date Employment Began
Employer Address
Street Address Address Line 2 City State ZIP Code
Employer Phone
Current Title/Responsibilities
Title Since
Previous Employer Responsibility Date From Date To
What do you consider your highest responsibility, skill or career achievement to date?*
Education
Begin with high school, then college, business/trade schools and /or specialized training.*
School Name & City Degree/Major Date From Date To
Activity Service
Identify the volunteer role you are currently serving that is of most importance to you. Organization & Position*
Explain why you became involved, and why this activity is of importance to you.*
List up to five other community, civic, professional, business, religious, social, athletic, and other organizations of which you are or have been a member with your service hours per month.*
Organization Position Hours/Month Date From Date To
Please indicate any special recognition or awards for volunteer/service activities.
If you have previously not had the time or interest to become actively involved, what conditions have changed that now enable you to seek involvement in the community?
Issues & Objectives
Identify potential growth areas within your business and volunteer life. How do you think your involvement in Hancock Leadership will help you attain your growth potential?*
In your judgement, what do you consider as a pressing challenge that needs to be addressed by the people of Hancock County? Explain why, and identify your recommendations for approaching and resolving this issue.*
Personal References
Please provide the names of three (3) individuals familiar with your community activities to serve as references. No more than one business reference. References from family members are not advisable.*
Name Address Phone
Commitment for Participation
In order for Hancock Leadership to accomplish its mission and objectives, the full participation of each individual selected is required. This includes one full day per month of the program, a retreat, and participation in the service project with your fellow classmates. Attendance is required at a minimum of 7 of the 9 monthly sessions, with the retreat and class project being mandatory.
Will you be able to fulfill this commitment?*
Do you have the full support of your employer and family for the time to participate in Hancock Leadership?*
Finances & Scholarships
If you are accepted into the Hancock Leadership program, you or your company/sponsoring organization will be billed for the tuition fee of $895.00, which is due and payable by September 1, 2019.
Tuition bill sent to*
- Applicant
- Sponsor
If sponsor, whose attention should bill be sent to:
I am in need of scholarship assistance*
- Yes
- No
Signature
Applicant's Digital Signature*
By typing your name in the space provided, you confirm this form is correct.
Sponsor name
Sponsor Address
Street Address Address Line 2 City State ZIP Code

Findlay • Hancock County Chamber of Commerce

Findlay • Hancock County
Chamber of Commerce

Hancock Leadership Confidential Application

Hancock Leadership Class of 2021 Application

Personal

Employment

Education

Activity Service

Issues & Objectives

Personal References

Commitment for Participation

Finances & Scholarships

Signature

Previous Employer	Responsibility	Date From	Date To

School Name & City	Degree/Major	Date From	Date To

Organization	Position	Hours/Month	Date From	Date To

Name	Address	Phone

Findlay • Hancock County Chamber of Commerce

Findlay • Hancock CountyChamber of Commerce

Hancock Leadership Confidential Application

Hancock Leadership Class of 2021 Application

Personal

Employment

Education

Activity Service

Issues & Objectives

Personal References

Commitment for Participation

Finances & Scholarships

Signature

Findlay • Hancock County
Chamber of Commerce