Focus Lubbock 2011-12
Confidential
Application
Please print or type.
Do not use additional pages for this application.
May attach a current resume.
Applications are due May 31, 2011 by 5pm
attach a concerning
current resume.
Return the applications to your designated contact at your school. If you haveMay
a question
who is
the contact at your school, call the Lubbock Chamber of Commerce, 761-7003.
Personal Data
Name________________________________________________ Social Sec. #_____________________________
Last
First
Middle Initial
Preferred Name (for name tag)________________________________________ Male __ Female __ Age______
Current Lubbock Address________________________________________________________________________
_____________________________________________________________________________________________
City
Zip Code
Current/Lubbock Phone ________________________________ Cell Phone_______________________________
E-mail address___________________________ Shirt Size __ S ___ M ___ L ___XL ___XXL____Other ___
Indicate Men’s or Women’s Sizing
Do you anticipate staying in Lubbock after graduation? Yes_______ No__________
Summer Address: ______________________________________________________________________________
(So that we may contact you during the summer months)
_____________________________________________________________________________________________
City
Zip Code
Summer Email: ________________________________________ Phone Number ___________________________
Fall Lubbock Address: __________________________________________________________________________
_____________________________________________________________________________________________
City
Zip Code
Fall Email: ___________________________________________ Phone Number: __________________________
Education & Career Goals
Briefly summarize your educational and career goals. List major, professional and academic honors. List high
school/college honors or achievements.
MAJOR: _______________________________________________
For Office Use Only. Date_______CK#_______ID#________
Page 1 of 4
Applicant Commitment
To graduate from Focus Lubbock a participant is required to attend all monthly full-day sessions, from September through April.
Focus Lubbock days are scheduled for Fridays during the school year (with the exception of the Austin trip). Students will be
given letters for faculty members about their participation in Focus Lubbock. Each student is responsible for the completion of
any missed class work or assignments while participating in Focus Lubbock. We will not meet during Christmas break or
Spring break. ONLY 2 ABSENCES ARE ALLOWED. Participants must attend all portions of a session in order to
receive credit for that session.
Past day topics have included Community & Business Development Day, Agricultural Day, Medical Issues Day, and
City & County Government Day, and State Government Day. 2011-12 dates to be determined.
Will you be able to fulfill this time commitment? ___Yes ___ No
I give _________________________ permission to verify my academic and disciplinary standing.
(school name)
I understand the purpose and commitment of the Focus Lubbock program; and, if I become a participant, I will
devote the required time.
___________________________________________
Signature
____________________________________
Date
Participant Selection & Criteria
Applications must be signed by candidate and returned to the
designated person at your school– no later than May 31, 2011.
Contact the Lubbock Chamber of Commerce for information concerning where to turn in your application.
806/761-7003
Participating Colleges/Universities
 Lubbock Christian University
 South Plains College
 Texas Tech University
 Texas Tech University Health Science Center
Qualifications:
 Participants must be enrolled as full-time college/university students for fall 2011 and spring 2012.
 Participants must have a minimum 2.5 cumulative and current grade point average for consideration.
 Junior and senior classifications will be given preference.
Selection Process:
 Each college/university has their own selection process.
 All applicants will be notified by mail and/or phone of their acceptance or non-acceptance byJune 1, 2011.
For Office Use Only. Date_______CK#_______ID#________
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Community Needs
In your judgement, what are the three most pressing problems facing Lubbock or the Lubbock area? Or what are
the three most pressing problmes facing your university or college today? Explain your choices and give
recommendations you have for approaching and resolving these problems.
General
What specific skills/knowledge do you hope to gain from your participation in Focus Lubbock?
For Office Use Only. Date_______CK#_______ID#________
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Organizations/Activities/Community Involvement
Please list the school, work, athletic, cultural and community related organizations of which you have been a
member and that have been of significance to you.
Organization
From
To
Responsibility/Positions Held
What work/community/school awards or recognition have you received? When?
What do you consider your most important accomplishment in one of the above organziations/work? Why? What
role did you play?
How much time each month do you spend on extracurricular activties with the above identified organizations?
If you have not had the time or interest to become actively involved, what conditions have changed that now enable
you to seek involvement in the community?
Are you interested in staying in Lubbock after graduation? Why or why not?
What other information would you like us to know about you?
For Office Use Only. Date_______CK#_______ID#________
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