2015-2016 APPLICATION
LEADERSHIP CLASS is a Leadership Fort Worth program designed specifically for the established leader. To ensure the
quality of the experience, the class size is limited. More applications are typically received than can be accepted. To assist
the Selection Committee in giving all applicants the fairest consideration, please complete the following steps:
1.
Download the Application Form. Once the form is complete return to the web page and upload the completed
application form and photograph (jpg or png, please.)
2.
Remit a $50.00 application fee on line. (Application fee increases to $100.00 on 04/17/15.)
3.
Download the Recommendation Form and provide electronic or hard copy to three endorsers.
4.
Download the Class Calendar and retain for your records.
Your application, application fee, photo and recommendation forms must be received by Leadership Fort Worth no later than
Friday, May 1, 2015. For a reduction of the application fee, please send all applications material by the Early-Bird Deadline
of April 17, 2015. Incomplete or late applications will not be considered. Do not remit tuition payment with your application.
The 2015-2016 Leadership Class will be announced the week of June 1.
The Selection Committee seeks individuals who:
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Have a record of achievement in community/civic activities
Have demonstrated a concern for their community through active involvement
Has undertaken several key leadership roles in the community.
Possess high standards of personal quality and integrity.
Can and will commit the time required for the program.
If employed, have the endorsement of their employer.
Note: We encourage younger candidates who are seeking a higher level of community involvement to consider applying for
the Leading Edge program. Applications will be accepted during the fall of 2015 for the Leading Edge class of 2016
(January 2016 – June 2016). Please go to www.leadershipfortworth.org for further information.
Please contact Pam Cannell, pam.cannell@leadershipfortworth.org, with questions.
2015-2016 APPLICATION
EARLY-BIRD DEADLINE FOR APPLICATION: Friday, April 17, 2015 – Fee $50
FINAL DEADLINE FOR APPLICATION: Friday, May 1, 2015 – Fee $100
TUITION WAIVER REQUESTED
Yes
See the last page of the application form for information.
No
PLEASE TYPE:
Name:
Last
First
Middle
Preferred Name
Company:
Company Name
Business Address:
Mailing Address
Business Phone
City State Zip
FAX
Home Address:
Mailing Address
Home Phone
Date of Birth:
Current Position
Cell Phone
Email Address
City State Zip
Home Email
Month Day Year
Ethnic Background:
Anglo
Spouse
Gender
African-American
Asian American
No. of Employees
Hispanic-American
American-Indian
Other
Multi-Racial
Have you previously applied for admission into the Leadership Class of Leadership Fort Worth?
No
Yes
If yes, what year(s)? _____________________
2015-2016 APPLICATION
Describe Your Position and Responsibilities At Your Current Employer:
Leadership Fort Worth seeks to provide a diverse class of participants to represent all sectors of our community. Please
check one from each of the following lists:
Organization Type (circle one):
BgBiz
SmBiz
GovPu
Civic
Other
Big Business (>100 employees)
Small Business (<100 employees)
Government/public sector
Civic/Non-Profit
Industry Type (circle one)
Art/Entertainment
Banking/Insurance
Consulting
Construction
Energy
Faith
Healthcare
Manufacturing
Real Estate/Development
Retail
Utilities
Architecture/Engineering
Community Volunteer
Community Organization
Education
Finance/Accounting
Law
PR/Advertising
Media/Communication
Retired
Social Service
Community/Civic Participation:
List key community, civic, and religious boards, task forces or commissions in which you have been an active participant. (If
you have moved to Fort Worth recently please list activities you were involved with in your previous community.)
Organization:
Dates Involved:
Offices/Position Held:
Special honors or awards, if any:
For an average month, give the approximate number of hours you spend on volunteer, civic, cultural, religious or political
activities, committees or boards:
2015-2016 APPLICATION
NO ATTACHMENTS ARE PERMITTED TO ANSWER QUESTIONS ON THIS PAGE.
Limit all answers to 50 words maximum.
Describe what you consider your most significant contribution to the community (or former communities).
What civic/community volunteer experience do you expect to be involved in five years from now?
What do you hope to gain from participation in Leadership Fort Worth that will help you achieve these community leadership
goals?
What do you consider to be the two most significant challenges facing Fort Worth today? Choose one and discuss how you
hope your Leadership Class experience will contribute to its solution.
2015-2016 APPLICATION
I have the full support of my employer for the time required to participate in Leadership Fort Worth. Tuition for the program
is $2,500 payable by July 1, 2015.
Send statement for $2,500 tuition to: (Check one and provide name and mailing address.)
Company
Name
Organization
Applicant
Other
Mailing Address
Tuition Waiver: A few partial tuition waivers are available. All applicants are responsible for at least the first $1250. Tuition
waivers are awarded solely on the basis of documented financial need and availability of funds. Proof of financial need may
be requested. Tuition waiver amount requested: $
If you are requesting a tuition waiver, please explain the circumstances.
I hereby give LEADERSHIP FORT WORTH the right to make inquiries regarding the information provided on this application.
Signature
Date
The size and make up of each LEADERSHIP CLASS is carefully considered to ensure that it is broad based, representing a
variety of professional, economic, social, and ethnic backgrounds. This means that many highly qualified applicants cannot
be accepted the first year they apply. We encourage you to re-apply should you not be accepted this year.
All Leadership Class application materials should be submitted online or via U.S. mail to:
Leadership Fort Worth, P.O. Box 11371, Fort Worth, TX 76110
Or send by courier/hand delivery to:
Leadership Fort Worth, 2330 Mistletoe Drive, Fort Worth, TX 76110