Leadership Kingsport Application

This program provides opportunities for leaders and emerging leaders from various sectors of the community to study local and regional issues, and to further develop their leadership skills.

Program Founded in 1983, Leadership Kingsport is a program of the Kingsport Chamber of Commerce. Approximately 30 – 35 area residents are chosen each year to participate.

Leadership Kingsport's mission is "to develop leaders who give life to community dreams." Anyone interested in serving the community is encouraged to apply.

Selection Criteria Selection of Leadership Kingsport participants will be based on:  Interest in serving on boards, commissions, in volunteer roles and/or in public office.  Demonstrated commitment, motivation, and interest to serve the community.  Recognized leadership ability in community, civic, professional or other organizations.  Attaining a cross section of participants from business, government, community service, minorities, etc. Class Schedule Orientation – August Mandatory Retreat – September Program Days are normally the second Thursday of each month, October - May, 8am-5pm. Mandatory Nashville trip – March Full attendance and participation in the Leadership Kingsport program is expected. Orientation, Retreat, Nashville trip, and Community Impact Projects Day are mandatory. Attendance at all program days is expected (any absence must be approved and make-up work completed in order to be eligible for graduation)

Requirements Applicants must be 21 to apply Individual interviews will be held during the month of June.

Tuition Non-refundable tuition covers retreat, food, lodging, training materials, monthly training sessions (including lunch), and all administrative costs. Tuition is $1,250.

If there are questions, please contact Vanessa Bennett at 392-8813 or [email protected]. APPLICATION

Contact Information

Name ______

Age ______Sex______Years lived in Kingsport Area ______

Home Address ______

______Home Phone ______City State Zip

Work Phone ______Cell Phone ______

E-Mail Address ______

Spouse’s Name ______Age(s) of children ______

Employment Information

Employer ______

Address______

______City State Zip

Position ______Years with Employer______

Immediate Supervisor ______Phone ______

What are the Primary Elements of your Job ______

______

Has your employer (or some other organization agreed to pay your tuition? ______No ______Yes Organization or Employer

Mail any correspondence to: ______Home address ______Work address List up to five community, civic, professional, business, religious, social, athletic and/or other organizations in which you are an active volunteer and describe briefly your involvement.

1. ______

______

2. ______

______

3. ______

______

4. ______

______

5. ______

______

______List up to five leadership positions you have held and briefly describe your role/responsibility/experience.

1. ______

______

2. ______

______

3. ______

______

4. ______

______

5. ______

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How do you see yourself being involved in the community in the future?

______

What do you believe are the three most important issues facing the Kingsport area?

______

Choose one of the issues identified in the previous question and elaborate on your reasons for

selecting it and addressing it.

______

SIGNATURE______DATE______

On behalf of Leadership Kingsport and the Kingsport Chamber of Commerce, thank you for demonstrating interest in the Leadership Kingsport program by completing this application. Since we have a large number of applications for a limited number of positions, we may not be able to place you in this year’s class. If you are not selected for this year’s class, may we consider your application active for the next class? __Yes __No

PLEASE RETURN TO: Leadership Kingsport, c/o Vanessa Bennett Kingsport Chamber of Commerce 400 Clinchfield Street, Suite 100 Kingsport, TN 37660 Phone (423) 392-8813 Fax: (423) 392-8834 [email protected]

Leadership Kingsport Participant Agreement I understand that the purpose of Leadership Kingsport is to develop individuals who are able and motivated to assume community leadership positions. In order for the program to be effective and achieve its purpose, attendance at all sessions for the entire day by all participants is necessary. I understand the necessity of requiring attendance and will, if selected for this year’s class, agree to the following commitments (please initial all items to which you agree):

______I will attend the overnight retreat in September. If, for any reason, I am not able to attend the entire retreat, I understand that I will be removed from this year’s class and may be given the option of attending next year.

______I understand that I am expected to attend all program sessions and that 100% attendance or makeup requirement is necessary to graduate. The program days are generally scheduled the second Thursday of each month from October through May, from 8:00 a.m. to 5:00 p.m.

______I understand that any half-day or more missed will require make-up work in order to fulfill the attendance requirement and graduate and subsequent misses will be discussed.

______I understand that there is a community impact project that will require some meetings beyond the monthly program sessions and I agree to participate in it.

______I have discussed these requirements with my employer and have his//her complete support.

______My tuition of $1,250 will be paid. Limited scholarships are available.

Please print name of person or company to be billed.

______Date ______Participant Signature

______Date ______Supervisor Signature