Masters Leadership Class 7
Program Application
February – May 2016
NAME:
_
[First]
AGE:
[Last]
50 – 60 
MALE 
61 - 70 
FEMALE 
Over 70 
RACE/ETHNICITY: ________________
COMPANY & POSITION (present or past, if retired):
______________________________________________________________________
BUSINESS SECTOR (either currently or past, if retired):
(defense/aerospace, non-profit, education, healthcare, banking/finance, community
service, etc.)
PRESENT WORK STATUS:
Full time 
Part time 
Retired 
ADDRESS:
CITY, STATE, ZIP:
__________
HOME PHONE:
CELL PHONE:
WORK PHONE:
E-MAIL:
____
__________
TIME IN MADISON COUNTY: ________________________________________
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GRADUATE OF ANOTHER LEADERSHIP PROGRAM(S)? YES 
NO 
If yes, please list:
_________
YES 
IS SPOUSE OR FRIEND APPLYING?
NO 
If yes, please list:
_________________________________________________________
List top three personal objectives for participating in the Masters’ program.
____
____
____
____
List organizations in which you are currently involved or with which you have
been involved during the last five years as a member, board member or leader.
___
In what industries or sectors are your principal skills/expertise? (Please check all
that apply)
Academia
Entertainment/Culture
Nonprofit
Accounting/Auditing
Fashion/Apparel
Publishing
Advertising
Government/Public
Real Estate
Service
Banking/Finance
Health Care
Religious/Community
Service
Computers/Info.
Human Services
Restaurant/Hospitality
Systems
Consulting
Manufacturing
Utilities
Consumer Products
Media
Other:
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What program topics are you most interested in?
_____________________________________________________________________
How would you like to apply what you learn in the Masters Leadership Program to
your personal life, community and/or company?
Please note the Masters Leadership class includes activities that include
extended periods of sitting, moderate levels of walking, boarding/un-boarding a
tour bus, etc.
Do you have any dietary, health, or physical conditions that you would like to
make us aware of?
______________________________________________________________________
Program Dates:
Orientation – Friday, February 19
Day 1, Economic Base – Tuesday, March 1
Day 2, Human Services – Tuesday March 15
Day 3, Education – Tuesday, March 29
Day 4, Culture & Leisure – Tuesday, April 12
Day 5, Health – Tuesday, April 26
Day 6 – Government/Graduation – Tuesday, May 10
Application Deadline: Tuesday, December 8
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 Class size is 25 - 40.
 Primary age range is 50 +
 If accepted, you will receive email and mail notification.
 Tuition payment is due upon notification of acceptance to class.
 Tuition of $500.00 (plus $25 application processing fee) is non-refundable,
but may be deferred to the next class period provided we receive a 7-day notice of
withdrawal from the class prior to Orientation. Tuition is due by Class Orientation
on February 19, 2016 unless other arrangements are made with program director.
Payment plans are available if needed.
 Class member packets will be mailed week of January 25, 2016.
 Application does not guarantee selection.
In addition to submitting this form, please submit a short 100 word bio and a
digital photo (head and shoulders).
To submit your application, please return this form, along with bio and photo, to
Leadership by e-mail: mstewart@leadershiphsv.org , mail: P. O. Box 328, Huntsville, AL
35804, or fax: 256-512-0156.
Leadership Huntsville/Madison County
P. O. Box 328, Huntsville, AL 35804
Street Address: 659 Gallatin Street, Huntsville, AL 35801
(256) 489-2281 x 303 (phone), (256) 512-0156 (fax)
mstewart@leadershiphsv.org (e-mail) Contact: Mary Stewart, Program Director
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