Apply for 2018

Apply

Application

Before you submit the application below, please be sure to have your résumé, issue description and application fee ready. Please note, the application will automatically time out after 20 minutes. 

The deadline to apply for the Lead Virginia Class of 2018 is January 15, 2018.

Personal Contact Information

Prefix:
First Name:*
Middle Name:
Last Name:*
Preferred Name:*
Home Address:*
Home Address:
City:*
State:*
ZIP Code:*
Home Phone:*
Cell Phone:*
How did you hear about Lead Virginia?

Employment Information

Employer:*
Position or Title:*
Street Address:*
Suite:
City:*
State:*
ZIP Code:*
Office Phone:*
Fax:
E-mail:*
Website:
Assistant’s name:
Assistant’s phone:
Assistant’s e-mail: Assistant info will be added to our database/list serve.
Briefly describe your company or organization, including the sector (public or private business, government, education, nonprofit or other profession) and type (i.e., banking, utility, marketing, military, higher education, law or community services).*

Demographic Information

I live in a(n):*
I work in a(n):*
Age:*
Years in Virginia:*
Family (spouse, children or significant):
Please describe your race or ethnic background:*

Community and Leadership Education

Have you completed a community leadership program or other leadership education or training? If so, please list the program(s) and year(s) completed and note your volunteer or leadership roles.
How are you currently serving in your community, your region or the Commonwealth? List organizations and positions held.

Résumé

Upload Document:* (File must be MS Word, PDF, or plain text.)

Scholarship Assistance

Will scholarship assistance be necessary for you to participate in Lead Virginia?
If yes, how much assistance do you need?
Will lack of scholarship support preclude your participation in the class?
Please explain your reason for your request.

Issue Description

Describe your personal views on the following topic: What are the two most pressing issues or challenges facing Virginia today? Explain why and offer recommendations for approaching and solving these challenges. The suggested length of response is no more than one-half page.

Upload Document:* (File must be MS Word, PDF, or plain text.)

Statement of Commitment

Attendance at the opening session, April 19-21, 2018 is mandatory. Attendance at all other programs is strongly urged. Participants who miss more than two sessions will be asked to withdraw.
I understand Lead Virginia's attendance policy and will participate in all programs to the best of my ability.