PERSONAL DATA

Name (last, first, middle initial):

Mr. Mrs. Ms. Prefer to be called:

Home

Address: City, State, Zip:

Phone:

Email (Required):

Fax:

Business/Organization

City, State, Zip:

Fax:

Name:

Address:

Phone:

Email (Required):

Send email correspondence to: Home Business

How long have you lived in the Lewis Clark Valley?

How did you hear about the Leadership LC Valley Program?

Confidential Application

Leadership LC Valley Program"It Starts With Us - Leadership

for a Changing World" Class of 2021-2022

The information in this application is used solely for the Leadership LC Valley Program’s selection process and will be limited to such use. All applications will be evaluated to represent a cross-section of businesses, professions, organizations, government, education, socio-economic backgrounds, and geographical areas through the Lewis Clark Valley.

APPLICATION DEADLINE: Thursday, August 26, 2021 by 4pm

CRITERIA Demonstrated commitment to, and interest in, serving the Lewis Clark Valley in a leadership role

Willingness to commit time and energy to completing the program

Resident of the Lewis Clark Valley or ability to demonstrate significant current community involvement in the region

Demonstrates leadership skills/qualities

INSTRUCTIONS Download application, save to computer, type in responses - all applications must be typed, saved, and submitted electronically to events@lcvallleychamber.org by 4:00pm on Thursday, August 26, 2021. Tuition must be paid in full by September 15, 2021.

Application must be completed in full and signed by the applicant and the applicant’s employer. Incomplete and/or late applications will not be accepted. Tuition is $900 and is non-refundable and non-transferrable.

Completed application accompanied by one professional letter of recommendation must be submitted electronically to events@lcvalleychamber.org no later than 4pm on Thursday, August 26, 2021.

Email a photo of you doing a hobby or activity you enjoy.

Age Group: 21-29 30-39 40-49 50+Gender: Male Female

Shirt Size:

Dietary Restrictions:

EDUCATIONList education background, beginning with high school, college(s), advanced degree(s), and/or specialized training

Name of School City/State Degree Major

EMPLOYMENTCurrent Employer:

Briefly describe your current job responsibilities:

Title:

Year Started: Are you subject to transfer? No Yes

List previous positions held with your present employer and other employment in reverse chronological order.

(Do not attach resume)

Employer Title/Responsibility From To

COMMUNITY INVOLVEMENTPlease list in order of importance to you, up to five civic, professional, or community organizations of which you are present, past orfuture member. Please note any leadership positions held.

Organization Title/Responsibility From To

What are you passionate about and how are you using this passion to make a positive impact on the Lewis Clark Valley?

What are your expectations of this program, your reasons for applying, and qualities you can bring to the success of this program?

REFERENCEApplication must be accompanied by one professional letter of recommendation (preferably by a current employer) that has knowledge

of your qualifications as a potential Leadership LC Valley Program participant.

ACCEPTANCE AND TUITIONNotification of selection into the Leadership LC Valley Class of 2021-2022 will be made by September 1, 2021. Upon acceptance into the

program, the tuition of $900 must be paid in full to the Lewis Clark Valley Chamber of Commerce no later than September 15, 2021.

My tuition will be paid by myself my employer other

What do you think the number one issue affecting our community is? Why?

*Denotes mandatory attendance

Applicants to Leadership LC Valley will be expected to become active participants in advancing the community and making a positive contribution

to the Lewis Clark Valley post-graduation.

Applicants must be legally eligible to tour facilities including law enforcement, ammunition and gun manufactures, as well as public and private

schools. COVID-19 vaccinations are encouraged and other measures will be taken to keep participants safe and healthy including, but not limited

to: face masks, social distancing, individually plated meals, etc. We appreciate your time and investment in the program and want to insure there

are no interruptions to our scheduled classes.

Graduates will be responsible for planning as well as attending one of the following year’s Leadership LC Valley class sessions (Class of 2021-2022) determined after commencement.

Leadership graduates are expected to be active participants in the committees which make up the Alumni Association’s programs and activities

throughout the year.

If selected as a Leadership LC Valley Program participant, I understand that I am committing myself to attending the retreat,

commencement, and eight monthly sessions, which includes fully involving myself in the activities at each and participating fully in the

class. Tuition is non-refundable. I also commit to involving myself in the community upon graduation from the program, and allowing

my name to be given out to community service organizations seeking volunteers.

Employer:

I understand the time commitment required in the Leadership LC Valley Program, and I support his/her involvement.

Applicant Signature: Date:

Employer Signature: Date:

SUBMIT: Completed 2021 Application

One Professional Letter of Recommendation

Email photo of you doing a hobby or activity you enjoy.

APPLICATION DEADLINE: Thursday, August 26, 2021 by 4pm

Kristina BickfordLeadership LC Valley: "It Starts With Us - Leadership for a Changing World" | Lewis Clark Valley Chamber of Commerce

Tel: 509-758-7712 | PO Box 1996, Clarkston, WA 99403

COMMITMENTAttendance Policy: Y our full attendance at the retreat, kick-off session, and commencement, as well as full participation in the class

is mandatory. During the retreat, you are required to stay on the premises from registration until conclusion.

Monthly sessions are held at various locations throughout the Lewis Clark Valley and surrounding areas from October 2021 to May 2022. You are expected to attend all of the monthly sessions. Missing more than 15 minutes of a session is considered a 1/2 absence.

Participants who have more than 2 absences will be withdrawn from the program and will forfeit their tuition.

Transportation is provided each month and is expected for participants to utilize this service.

* Retreat:September 24-25,2021

* SessionsOctober 22November 19January 7February 4March 4April 8May 6

* Graduation

May 2022

Expectations of Graduates: