Name:

Preferred Name:

Gender:

MaleFemale

Home Address:

Business Name:

Business Phone:

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Business Address:

Home Phone:

() -Second partThird part

Years Residing in Sumner County:

Fax Number:

() -Second partThird part

Email:

Spouse’s Name:

Ages of Children:

Employment

Present Employer:

Date of Hire:

Previous Employment (in reverse chronological order):

Employer,Title/Responsibility,Dates of Employment

What do you consider your highest responsibility, skill, or career accomplishment thus far? Why?:

How many days per month does your work require you to be out of town?:

Education

Begin with high school, then list training and/or education beyond that period.:

Name of school, Dates attended, Degree/Major

Extracurricular activities and special honors for leadership and/or academic performance (please indicate school):

Organizations and Activites

List up to five (5) community, civic, professional, business, religious, social, athletic and other organizations in which you have been involved:

What have you accomplished in these activities that you deem important?:

Have you been active in community, civic, professional, and other activities as you would like? If not, what have been major barriers to your becoming involved?:

General

What do you hope to gain from your Leadership Sumner experience?:

Have you previously applied to Leadership Sumner?:

YesNo

If so, when?:

Essay Question

What do you consider the three most pressing problems/issues facing Sumner County? Please provide an explanation of why and recommend solutions/alternatives for approaching and resolving and/or overcoming these problems/issues.:

Participants are required to attend each class throughout the Program. However, you will be allowed to miss one full session. Outside of scheduled sessions, the Program also requires a time commitment. Absenteeism will result in your being unable to participate in graduation with your class. In order to be able to graduate with the next year’s class, you will be required to make up the class missed the following year or you will be dropped. If you are unable to make this commitment, it is not in your best interest to apply at this time. Wireless phones and beepers are not permitted.

Are you and your employer, (if applicable,) prepared to make this September – July commitment?

Please accept my application for Leadership Sumner. I understand the commitments of the program. If selected, I will fulfill the attendance commitment and pay the tuition upon acceptance.