APPLICATION

Leadership Lake Houston is a program of the Lake Houston Area Chamber of Commerce which identifies and develops future leaders for our community. The intent of the program is to develop new community leaders and enhance the skills and community awareness of existing community leaders by exposing participants to the challenges and opportunities in various segments of the Lake Houston Area. The goal of this process is to assemble a network of community leaders who can enhance their problem solving and other leadership abilities through shared perspectives and working together.

2015-2016 Class Schedule (8:30 am - 4 pm)DATE SESSIONAugust 25 Opening Reception (5:30 pm)September 17-18 Opening RetreatOctober 13 Social ServicesNovember 10 Quality of Life & HistoryDecember 8 GovernmentJanuary 12 HealthcareFebruary 9 EducationMarch 8 Business and Economic DevelopmentApril 12 Justice and Public SafetyMay 10 Class Project Day/Graduation

APPLICANT NAME: Click here to enter text.

SPONSORED OR REFERRED BY: Click here to enter text.

TUITION: $795 If received by 7/31/15. Late fee of $50 will be assessed on 8/1/15.

APPLICATION CHECKLIST (Deadline to submit all materials is 5 pm, May 29, 2014):☐One copy of completed application ☐Non-refundable $25 application fee. (Application fee is waived for Chamber members who are at or above the Partner Distinguished Investor level).☐Three References (Name, Company, Address, Phone Number, Email for each. *If you are in need of financial assistance, attach a letter explaining your need

IMPORTANT DATES:May 29: Application Deadline July 31: Tuition DeadlineJune 25: Applicant Acceptance Notification August 25: Opening Reception

CONFIDENTIAL APPLICATION FOR APPOINTMENTLEADERSHIP LAKE HOUSTON 2015-2016

A program of the Lake Houston Area Chamber

PERSONAL INFORMATION DATE: Click here to enter a date.

APPLICANT FULL NAME      

PREFERRED NAME       ☐MALE ☐FEMALE

COMPANY NAME      

BUSINESS MAILING ADDRESS Address, City, State, Zip      

BUSINESS PHONE      

BUSINESS EMAIL      

PREFERRED EMAIL ADDRESS (If different from Business Email)     

HOME ADDRESS Address, City, State, Zip      

HOME PHONE       CELL PHONE      

EMERGENCY CONTACT NAME & RELATIONSHIP      

EMERGENCY CONTACT PHONE      

AGE RANGE: Choose an item.

LENGTH OF RESIDENCY IN THE LAKE HOUSTON AREA      

HOBBIES:      

Do you reside AND work in the Lake Houston Area? Y/N.

If “NO”, please explain your motivation for wanting to participate in this program.      

EMPLOYMENT INFORMATION

PRESENT EMPLOYER       START DATE Click here to enter a date.

TYPE OF ORGANIZATION      

CURRENT TITLE       SINCE Click here to enter a date.

RESPONSIBILITIES      

LIST PREVIOUS EMPLOYMENT IN REVERSE CHRONOLOGICAL ORDER:

EMPLOYER TITLE/RESPONSIBILITY DATES FROM-TO (M/YR – M/YR)

                 

                 

                 

                 

BUSINESS/PROFESSIONAL AFFILIATIONS (Not including civic organizations or political activity):

NAME OF GROUP POSITION HELD PERIOD OF AFFILIATION

                 

                 

                 

                 

Briefly describe your tenure in your chosen field. Note years of service and describe growth of responsibility.     

What do you consider your highest career achievement to date?     

EDUCATION

SCHOOL NAME & LOCATION DATES ATTENDED

MAJOR DEGREE

                                                                                            

Other certifications or training programs:     

COMMUNITY INVOLVEMENT

Include community, civic, religious, political, governmental, social, athletic or other activities. Do not include business/professional activities.

ORGANIZATION DATES OF INVOLVEMENT RESPONSIBILITIES

                 

                 

                 

                 

List any significant achievements or recognition you’ve received from your community work.     

HOW MUCH TIME DO YOU COMMIT TO VOLUNTEER PER MONTH?      

In what kinds of volunteer activities would you like to become involved in the future?     

If you have not had time to become actively involved, what conditions have changed now enabling you to seek involvement in the community?     

GENERAL INFORMATION

What, specifically, do you hope to gain from your involvement in Leadership Lake Houston?     

What are the three most notable opportunities in the Lake Houston Area?

1.      

2.      

3.      

What do you feel needs to be done to develop one of these opportunities?     

What other things would you like the selection committee to know about you?     

Would you require financial assistance? Choose an item.If yes, please include a letter requesting financial assistance. Please note availability of scholarships is not guaranteed. Scholarships granted will not exceed 50% of tuition costs.)

PROGRAM REQUIREMENTS• Attendance is required for all sessions. Dates are tentative, but should be finalized by the opening reception. After the year begins, dates will not change unless absolutely necessary and you will be given ample notice. Arriving on time at the designated locations for each session is required. Time will be docked for arriving late, leaving early, or leaving during a session.• If a bus is provided for any session, you are required to ride with the class. • You are expected to complete any outside assignments. Information about outside assignments will be given at the Opening Reception.• You are only allowed to miss eight (8) hours total during the Leadership Lake Houston year. Any tardy or partial days will be included in this eight (8) hour total. The only exception is that attending the entire Opening Retreat and Class Project Day is mandatory. • Cell phones and pagers must be turned off during session times. Phones must be on vibrate during sessions and text messaging during sessions is prohibited. Breaks will be allotted for checking messages and returning calls. In case of an emergency, Chamber staff will know how to contact class participants.• At the end of your leadership year, you will be strongly encouraged to engage in a volunteer commitment in the Lake Houston Area community.• Upon acceptance into the program, tuition is due in full and is non-refundable.

COMMITMENT STATEMENTPLEASE PRINT AND FILL IN THIS PORTION BY HANDI have read all the above program requirements, and I agree to the following mandatory guidelines for Leadership Lake Houston. I understand that to graduate from Leadership Lake Houston, I must:(Please initial each item to acknowledge requirement and sign below)

____ Be in attendance for the entire Opening Retreat (a two-day, one night session in September)

____ Attend all sessions (exceptions are made for missing 8 hours)

____ Attend the entire class project time

____ Complete outside assignments (riding with police officers, attending a school board meeting, etc. Information will be provided at the Opening Reception)

____ Use the transportation provided by Leadership Lake Houston, when applicable

____ Agree that any photos taken during any Leadership Lake Houston session may be used for publicity purposes.

I have cleared my calendar to participate in the Leadership Lake Houston Program. I commit to attending the opening retreat, all sessions and the graduation ceremony. If selected, I will devote the time necessary to complete the program. Even though emergencies do arise, any participant missing more than eight hours, for whatever reason, may be asked to withdraw from the program. I realize that if I voluntarily withdraw from the program, or am asked to leave the program, my tuition will not be refunded.

__________________________________________________________________________________________Applicant’s Signature Date

EMPLOYER COMMITMENT (Skip this if you are self-employed or if this is not applicable)

This application has the approval of this organization. The applicant has our full support which includes the time required to participate in the program. We also agree to pay $795 in tuition costs for this applicant to participate in the program.

______________________________________________________________________________________Signature/Printed Name

______________________________________________________________________________________Title

Applications are be due by May 29at 5:00 p.m.Selected applicants will be notified by June 25.

RETURN APPLICATION MATERIALS TO:Jenna Armstrong, President

Lake Houston Area Chamber, 110 W. Main, Humble, Tx 77338281-446-2128 • jarmstrong@lakehouston.org