MISSION  STATEMENT
Leadership  Hardee  is  dedicated  to  building  a  network  of  community  leaders  who  will  utilize  their  diverse  talents,  skills,  and  unique   perspectives  to  address  community-­‐wide  challenges,  identify  viable  alternatives,  and  help  solve  problems  facing  Hardee  County   today  and  in  the  future.
APPLICATION
DEADLINE:  Close  of  Business-­‐August  14,  2015
PLEASE  RETURN  TO:
Hardee  County  Chamber  of  Commerce
P.O.  Box  683
135  East  Main  Street  |  Wauchula,  FL  33873
PERSONAL  INFORMATION
NAME_______________________________________________________________________________________________________
Last   First   Middle
MALE_____  FEMALE_____   DATE  OF  BIRTH____________________   YEARS  IN  HARDEE  COUNTY_____________________
HOME  ADDRESS_______________________________________________________________________________________________
Street               City         Zip
BUSINESS  PHONE_____________________________________HOME  PHONE_____________________________________________
CELL  PHONE____________________   .
EMAIL___________________________________________________
BUSINESS/ORGANIZATION  REPRESENTING  _________________________________________________________________________
____________________________________________________________________________________________________________
Street                   City         Zip
EDUCATION
Beginning  with  high  school,  college(s),  business  or  trade  schools  and/or  other  specialized  training
Name
______________________________
______________________________
City
_________________
_________________
Dates
_______________
_______________
Degrees
____________________________
____________________________
______________________________
______________________________
______________________________
_________________
_________________
_________________
_______________
_______________
_______________
EMPLOYMENT
____________________________
____________________________
____________________________
PRESENT  EMPLOYER_______________________________________________________
PRESENT  TITLE/RESPONSIBILITY______________________________________________
DATE  EMPLOYED______________
SINCE  (DATE)  _________________
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PREVIOUS  EMPLOYMENT
Begin  with  most  recent.
EMPLOYER                  TITLE/RESPONSIBILITY
_________________________________________   _______________________________________
_________________________________________   _______________________________________
_________________________________________   _______________________________________
_________________________________________   _______________________________________
DATES
_____________________
_____________________
_____________________
_____________________
_________________________________________   _______________________________________
ORGANIZATIONS  AND  ACTIVITIES
_____________________
Please  list,  in  order  of  importance  to  you,  up  to  three  (3)  community,  civic,  professional,  business,  religious,  athletic  or  other   organizations  of  which  you  are  or  have  been  a  member.
ORGANIZATION
_______________________________
_______________________________
_______________________________
DATES  OF  MEMBERSHIP
______________________________
______________________________
______________________________
POSITION(S)  HELD
____________________________________
____________________________________
____________________________________
GENERAL
HAVE  YOU  PARTICIPATED  IN  A  COMMUNITY  LEADERSHIP  PROGRAM  IN  THE  PAST?  IF  SO,  WHERE?
____________________________________________________________________________________________________________
LIST  ANY  ACHIEVEMENTS,  SPECIAL  HONORS  AND  AWARDS  RECEIVED  WITHIN  THE  LAST  THREE  (3)  YEARS.
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
HAVE  YOU  RECENTLY  ATTENDED  A  CITY  OR  TOWN  COUNCIL  MEETING?  __________________________________________________
HAVE  YOU  RECENTLY  ATTENDED  A  HARDEE  COUNTY  COMMISSION  MEETING?  ____________________________________________
HAVE  YOU  RECENTLY  ATTENDED  A  HARDEE  COUNTY  SCHOOL  BOARD  MEETING?  __________________________________________
IN  YOUR  JUDGEMENT,  WHAT  ARE  THE  THREE  (3)  MOST  PRESSING  PROBLEMS  FACING  HARDEE  COUNTY  TODAY?  EXPLAIN  WHY  AND
STATE  ANY  RECOMMENDATIONS  FOR  SOLUTIONS.
(1)__________________________________________________________________________________________________________
____________________________________________________________________________________________________________
(2)__________________________________________________________________________________________________________
____________________________________________________________________________________________________________
(3)__________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________
WHAT  DO  YOU  HOPE  TO  GAIN   FROM  YOUR  LEADERSHIP  HARDEE  EXPERIENCE?   ______________________________________________________
_______________________________________________________________________________________________________________________________________
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OPERATING  POLICY
•
Leadership  Hardee  is  governed  by  a  committee  within  the  Hardee  County  Chamber  of  Commerce.    The  Committee  consists   of  Chamber  board  members  and  community  leaders  who  have  a  keen  interest  in  the  Leadership  Hardee  program  and  its
promotion  of  Hardee  County.
•
The   Leadership   Hardee   program   shall   be   comprised   of   not   less   than   8,  and   no   more   than   10   class   sessions   over   a   nine   month  period.    Applicants  will  receive  the  schedule  prior  to  acceptance  in  the  program.
•
Leadership  Hardee  shall  seek  applicants  for  enrollment  strictly  within  the  membership  of  the  Hardee  County  Chamber  of
Commerce.    Applicants  will  be  encouraged  from  across  the  spectrum  of  people  representing  business,  civic,  cultural,  social,   and   governmental   entities   regardless   of   race,   color,   religion,   gender,   national   origin,   age,   disability,   marital   status,
political  affiliation,  and  sexual  orientation.
•
Leadership   Hardee   may   be   administered   by   the   Hardee   County   Chamber   of   Commerce   or   it   may   be   administered   by   a   qualified   individual/organization   selected   by   the   Leadership   Hardee   Committee.   The   Committee   shall   set   any
compensation  for  such  administrative  services.
• The  Leadership  Hardee  Committee  shall  adopt  an  annual  program  and  operating  budget  to  support  that  program  and  shall
establish  the  tuition  amount  required  to  fully  fund  all  program  activities.
•
The  Leadership  Hardee  Committee  shall  make  periodic  reports  to  the  Board  of  Directors  of  the  Hardee  County  Chamber  of
Commerce  in  order  to  assure  continuing  support  and  clear  communication.
Kick  Off  Dinner  &  Service  Project  Intro
Session  1
Session  2
Session  3
Session  4
Session  5
Session  6
Session  7
Session  8
Service  Project  Wrap-­‐Up
Graduation
SCHEDULE
September  1,  2015
September  9,  2015
October  14,  2015
November  2015  (TBD)
December  9,  2015
January  13,  2016
February  10,  2016
March  9,  2016
April  13,  2016
May  11,  2016
May  2016  (TBD)
Healthcare
Agriculture
Legal  System  &  County  Government
Education
TOPICS
Industry
Infrastructure
Law  Enforcement
Cultural  Resources
Page  3

PLEASE  SUBMIT  TWO  LETTERS  OF  RECOMMENDATION  WITH  APPLICATION.
All  applications  are  subject  to  confidential  evaluation,  and  participation  is  limited.    If  you  are  not  selected  to  this  Leadership  Hardee   class,  you  are  invited  to  resubmit  in  the  future.
If   accepted   into   the   Leadership   Hardee   program,   you   will   be   billed   a   tuition   fee   of   $500.00,   which   covers   the   entire   cost   of   the   program.
I  have  reviewed  the  attached  schedule  and  fully  understand  attendance  is  REQUIRED  at  all  sessions  including  the  kick  off
to  abide  by  these  terms.
commitment.
Signature
Date
Employer/Supervisor  Signature
(If  Applicable)
RELEASE  AND  HOLD  HARMLESS  AGREEMENT
Date
In  consideration  of  being  allowed  to  participate  in  the  above  program,  I  do  hereby,  for  myself  and  for  my  heirs,  assigns,   executors   and   personal   representatives   release,   waive   and   hold   harmless   Leadership   Hardee,   the   Hardee   County
Chamber   of   Commerce   and   its   officers,   agents,   employees   and   volunteers   and   all   other   entities   involved   with   this   leadership  program  from  any  and  all  claims  or  causes  of  action,  including  personal  injury  and  property  damage,  which   may   result   from   or   arise   of   my   participation   in   the   Leadership   Hardee   Program.   I   hereby   acknowledge   that,   if   I   am   chosen  to  participate  in  the  Leadership  Hardee  Program,  I  will  be  doing  so  on  my  own  initiative  and  at  my  own  risk.
__________________________________________________________________________________________________
Signature  of  Applicant                     Date
TWO  WITNESSES
__________________________________________________________________________________________________
Witness  Printed  Name         Witness  Signature         Date
__________________________________________________________________________________________________
Witness  Printed  Name         Witness  Signature         Date
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