> Adult Application 1

Personal Information













EMPLOYMENT INFORMATION (current employer)







PREVIOUS EMPLOYMENT HISTORY (most recent first)











LEADERSHIP INVENTORY






COMMUNITY

A. Please list community, civic, professional, business, religious, social, athletic or other organizations in which you have been a member. (5 points)





















VISION



EDUCATION

Please enter most recent first.














OTHER INFORMATION

How did you become aware of the Leadership Kearney program?








PERSONAL COMMITMENT

I understand the purposes of the Leadership Kearney program and, if I am selected, will devote the time and energy necessary to make it a successful experience.  I also understand that my submission of this application does not guarantee my acceptance into the program.                                    

Furthermore, I understand that my conduct at all times represents the Leadership Kearney Program.  As a role model, I pledge to make positive decisions that would be expected from a leader my community.  I understand that inappropriate or illegal conduct outside of Leadership Kearney activities may lead to my dismissal from the program.                                                                        

I will attend all sessions in their entirety.  Even though emergencies do arise, I understand that full participation is expected for all sessions. 

Failure to comply with attendance and participation policies will result in dismissal from the program and forfeiture of tuition.  Are you and your employer, if applicable, willing to make such a commitment?






References

Two typed references are required.  Please submit letters of reference (via mail, email or dropped off at the Chamber office) by Wednesday May 31st. to:             

Shanna Schulte at SSchulte@kearneycoc.org

Mail to:                                 

Leadership Kearney
PO BOX 692
Kearney, NE 68848

Drop Off:

Kearney Area Chamber of Commerce
1007 2nd Ave
Kearney, NE

 

If you have questions, please contact Shanna Schulte of the Kearney Area Chamber of Commerce: Phone: 237-4671 Email: SSchulte@kearneycoc.org

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Kearney Area Chamber of Commerce
Kearney Area Chamber of Commerce

1007 2nd Ave  •  PO Box 607  •  Kearney, NE 68848
Phone: 308-237-3101