2010 Leadership Macon - Application (Microsoft Word)

Leadership Macon
Send to:
Kathy Huber or Lona Vinson
Macon County Chamber of Commerce
685 Highway 52 Bypass West
Lafayette, TN 37083
Fax (615)666-6969
Complete and return as soon as possible. Application must be typed or printed in dark ink. Please fill
out completely; application form will be used in the selection process. Incomplete (except where
optional) or late applications may not be considered.
Personal Information / Employment
Date of Birth
Home Address
Business Address
Telephone Numbers: Home
E-mail address
Employer (if applicable)
Present title or responsibility
Since (date)
Education / Experience
What do you consider your greatest accomplishment, skill, or career achievement?
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Organizations / Activities
Please list, in order of importance to you, up to three community, civic, professional, business, religious,
social, athletic and other organizations of which you are or have been a member.
Approximate Dates
Official Positions Held
What have you accomplished in these activities that you think is important?
How much time each month do you commit to community, civic, professional and other organizations
and activities?
Have you been as active in community, civic, professional and other activities as you would like to be?
If not, what have been the major barriers to your becoming involved?
Participation / Commitment
To graduate from the Leadership Macon program, participants are expected to attend all sessions, however
one excused absence may be allowed.
 We will attempt to develop our meeting schedule based on the dates and times available for the members
of the class.
 Graduation banquet date and time will be determined by class members.
Are you and your employer willing to make such a commitment: _____yes ______no (Excessive
absenteeism will result in the participant being dropped from the course. If you are unable to make the time
commitment, it is not in your best interest to apply at this time.)
How long have you lived in Macon County? ________________
Do you reasonably expect to still be living in Macon County in 5 years? _____yes _____no
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Tuition for Leadership Macon County is $_100.00__ which covers all costs, including meals. If
accepted into the program, tuition must be paid at orientation. Tuition may be paid by a sponsoring
organization (such as an employer). Please submit tuition with your application if possible. This amount
is refundable if not selected.
Community Analysis
Are you a registered and active voter?
What do you hope to gain from your Leadership Macon County that will benefit the community?
Please identify a particular challenge, issue, or problem you feel is critical to Macon County. Explain
your concern and possible involvement in the solution of this issue:
Name (Print)
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