General
Information
To be eligible for consideration, all data fields must be completed. |
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Your Full Name: |
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Name you go by: |
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Home Address: |
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City: |
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State: |
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Zip: |
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Home Telephone: |
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Cell Phone: |
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Number of Years lived in Reno County: |
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Number of Years worked in Reno County: |
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21 Years or over?: Yes
No
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| Employment |
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Current Employer: |
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Address: |
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City: |
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State: |
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Zip: |
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Telephone: |
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Current Title or Responsibility:
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| Email
Address and Mailings |
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Communication with class members will
be via e-mail. List an e-mail address you prefer to
use. If you do not have an e-mail address, indicate
which address (home or work for mailings). |
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Email: |
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Please send Mailings to: Work
Home
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Answer the Following Questions: |
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1. What do you hope to gain from the Leadership
Reno County experience?
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2. After this experience, how do you intend
to get involved in the Hutchinson/Reno County community?
What specific organizations (community, civic, professional,
business, religious, social, athletic, etc.) do you
plan to get involved with?
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3. In your judgment, what are three challenges
or opportunities facing Reno County today? What are
your recommendations for approaching and resolving them?
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4. List other information you may wish
to make available to be considered in the selection
process.
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5. The tuition fee is $450. A limited number of partial
and full scholarships are available. If scholarship
assistance is needed, please contact Lynette Lacy,
lynette@klconnections.com (620-669-7954)
to request a scholarship application.
Scholarship Needed:
Yes
No
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6. Leadership Reno County class members
are required to attend all sessions, including a two-day,
one-night overnight retreat. In addition to the sessions,
participants will spend time outside the "formal
sessions" to complete at least 10 visits to various businesses
and organization; to practice leadership skills; and
to complete a class project. Any absence, regardless
of reason, must be excused by one of the co-chairs.
Participants unable to attend all sessions may, at the
discretion of the co-directors, be withdrawn from the program.
In such cases, there will not be a tuition refund.
If selected, I can devote the required time to the
program:
Yes
No
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7. Have you applied for the Leadership
Hutchinson or Reno County program before?
Yes
No
If yes, what Year(s)?
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Before submitting, it is recommended that you print a copy of this application. Once you click on "Submit" all data in the fields is removed.
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