Boone County Leadership Class Application for 2015

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Boone County Leadership
Class Application for 2015-2016
CONTACT INFORMATION:
Name
Email Address
Home Address
Cell Phone
Employer
Employer Address
Employer Phone
Current Position
COMMUNITY INVOLVEMENT: List any involvement in community, social, and professional organizations.
Organization
Dates
Position
Comments
GENERAL POLICIES:
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An anonymous committee of community leaders will conduct the applicant selection process.
15-25 professionals are chosen for the class each year.
Class composition endeavors are to be reflective of the county.
Attendance at the orientation, graduation and 7 out of the 9 classes is mandatory. The regular monthly
classes begin at 9 am and end at 3 pm. Some class times may vary.
Boone County Leadership 102 N. Lebanon St. Suite 200, Lebanon, IN 46052 Phone: 765.482.0024
SCHOLARSHIPS:
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A limited number of partial scholarships of up to one-half of the total tuition are provided by the Community
Foundation of Boone County. In order to qualify you must be employed with a nonprofit located in Boone
County. The scholarship is available to one individual per organization. The balance of the cost must be
matched by the affiliated not-for-profit. Please state in two paragraphs or less why you should be selected as a
partial scholarship recipient. Include your current or planned community involvement and how you anticipate
Boone County Leadership will be of benefit to you.
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COMMUNITY ISSUES: (provide answers on a separate sheet; no longer than two typed pages)
1. How did you hear of Boone County Leadership?
2. What do you hope to gain from the Boone County Leadership Program?
3. What do you feel are the two most pressing problems facing Boone County?
4. Given the most pressing problems, you’ve outlined facing Boone County, how do you want to make a
difference?
APPLICATION AGREEMENT:
I understand the time commitments of the program to which my employee has applied and agree to afford
him/her the time away from his/her employment to complete the program. (If you are self-employed or work
from home, no signature is required.)
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Employer
_____________________________
Date
Boone County Leadership 102 N. Lebanon St. Suite 200, Lebanon, IN 46052 Phone: 765.482.0024
REQUIRED DATES OF PARTICIPATION:
Dates TBD, currently looking at the first or second Tuesday/Wednesday of the month. Classes begin in
September (orientation) and conclude in May (graduation).
*Orientation
Agribusiness/Agriculture
Healthcare
Law Enforcement/Court System
Indiana Statehouse
County Growth/Municipal Planning & Zoning
Education
Warehousing/Manufacturing
*Human Services/Graduation
*Mandatory Attendance
By signing below, I acknowledge that I have read, understand and agree to the following:
I understand the time commitment is for September 2015 through May 2016 as outlined that 80% attendance
is required.
I also understand that:
 Attendance is MANDATORY at the orientation and graduation.
 Missing any time during the program classes will count as 1/2 day (leaving early, arriving late)
 A tuition fee of $499 will be invoiced to accepted applicants
 My signature warrants that all information contained in this application is true and correct.
 Attend local government, school and other meetings as required.
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Applicant signature
______________________________
Date
1. Questions or concerns:_________________________________________________________
2. Dietary restrictions:____________________________________________________________
3. If you are selected to participate, will you need a tuition invoice?_________________________
If so, can the invoice be emailed to the business or individual?_____________________________
4. Email address for invoice________________________________________________________
Boone County Leadership 102 N. Lebanon St. Suite 200, Lebanon, IN 46052 Phone: 765.482.0024
Email applications to: Gabi Youran, Director of Community Relations – Community Foundation of Boone County
at [email protected] Any questions, call 765-482-0024 or 317-873-0210.
Applicants will be notified within 30 days of receipt of the application for approval.
Once the applicant is approved, please send a check payable to Community Foundation of Boone County (or
CFBC) with "BCL" in the memo. Please include page one of application along with the check.
Community Foundation of Boone County
Boone County Leadership
102 N. Lebanon St. Suite. 200
Lebanon, IN 46052
Boone County Leadership 102 N. Lebanon St. Suite 200, Lebanon, IN 46052 Phone: 765.482.0024
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