THE CHALLENGE - Little Rock Regional Chamber



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A program of the Little Rock Regional Chamber

APPLICATION WORKSHEET INSTRUCTIONS

This document outlines the questions and information required for application to class XXXV of Leadership Greater Little Rock. To be accepted all information must be entered via the online application. Since the online portal does not allow for saving partially completed applications, we recommend using this document to draft answers and then copying them into the online application in one sitting. Completion of this worksheet DOES NOT constitute application to the program and will not be accepted in leu of an online application.

The entire application, signed commitment documents (signed by both the applicant and employer/sponsor) and all other related materials must be submitted to Leadership Greater Little Rock via the online application by Monday, June 10, 2019

Application must include the following to be considered:

1. Application

2. Attachments including:

• A recent photograph (any size, black/white or color)

• TWO letters of recommendation (required) –one from an employer or co-worker and one from a community source who can speak to applicant’s ability to meet selection criteria. Letters must be included WITH your application.

• Signature page with signatures of applicant and employer

All answers must be entered via the online application page:

leadership

Applications and reference letters are the property of the Little Rock Regional Chamber of Commerce and will remain confidential. If you have any questions regarding these forms, please call Melinda Moody at 377-6012.

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PERSONAL DATA

Name

Last ____________________________ First ____________________________

Name tags include first and last name. List only your first and last name as you would want your classmates to refer to you if you are selected as a class member.

Age___________

Male ___________ Female ____________Race (optional) _______________________

Employer:_______________________ Work Title:_____________________________

Employer Address________________________________________________________

Street Suite #

_______________________________________________________________________

City State Zip

Phones (W) ______________ (H) ______________ (C) _____________

*If you are selected, your cell number will be listed on the class roster (for class members only).

Email__________________________

Emergency Contact (name and phone #): _____________________________________

Home Address___________________________________________________________

Street Apt. #

________________________________________

City Zip

Place of Birth _______________________ Length of residence in Pulaski County_____

City State

Spouse’s Name if Applicable _______________________________________________________________________

Leisure Activities ________________________________________________________________________________________________________________________________________________

One unusual or “fun” fact about yourself (required)

Please do not list something you would not want to be shared with classmates.

________________________________________________________________________

________________________________________________________________________________________________________________________________________________

________________________________________________________________________

Have you participated in Leadership programs in other cities? Yes ____ No ____

If yes, please list cities and years _______________________________________________________________________

Have you previously applied to Leadership Greater Little Rock? Yes ____ No ____

If yes, in what year(s)? __________

BACKGROUND

• Employment (since graduation from high school or college through current; please include employment responsibilities)

• Business/Professional Affiliations (include professional/trade associations, civic clubs or other professional activities)

• Civic/Community/Volunteer Affiliations (may include civic, religious, political, government, social, athletic or other activities)

• Special Awards or Honors (include career or civic/community awards)

• Education (include high school, college and post graduate)

COMMUNITY INVOLVEMENT

All answers should be 300 words or less unless otherwise noted. Additional information beyond 300 words will not be considered.

• What leadership qualities do you possess and how have you used them?

• What do you believe are the two most significant issues or problems facing the Metro Little Rock area at this time? What action would you suggest to address one of these issues or problems? (500 words or less)

• Drawing from your life experiences, describe an example of your volunteerism.

• Why do you want to participate in the LGLR program and what do you expect to gain from it?

TUITION

If accepted into the Leadership Greater Little Rock program, you or your employer (or sponsor if other than employer) will be billed for the tuition fee of $1,900.

Tuition must be paid in full by Thursday, September 19, 2019.

Will your employer/sponsor pay the entire tuition fee? _______Yes _______No

If not, who will pay your tuition fee? ________________________________________________________________________

Will financial assistance be necessary for you to participate in the program?

_______Yes _______No

A limited number of scholarships are available. Scholarships are considered on a case-by-case basis and are usually reserved for individuals employed by non-profit organizations or with government or education agencies. To be considered for a scholarship, you must email Melinda to request an official Scholarship Form and it should be submitted with your application. Please contact Melinda Moody at mmoody@ or 377-6012.

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CONFIDENTIAL APPLICATION

LGLR Class XXXV

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