LNK 2011 Application
INSTRUCTIONS
  • Please complete each section in full, limiting answers to the space available. Completed applications must be returned with a check for $2,000 Chamber members, $2,300 non-members, no later than Fri. June 18, 2010. Class enrollees will be announced by Fri. July 9, 2010.
  • Applicants not selected will have their payments returned shortly thereafter.


PROGRAM SELECTION
  • Participation in Leadership Northern Kentucky is open to persons living in the Northern Kentucky and Greater Cincinnati area.
  • Since the number of participants to Leadership Northern Kentucky is limited (approximately 40 participants) and the number of Applications received far exceeds the number of selected participants, applicants who are not selected are encouraged to reapply in subsequent years.
  • Participants will be selected by the Leadership Northern Kentucky Selection Committee based upon information completed on the application and the confidential references supplied. The Committee will be seeking representation from a cross-section of the community. Participants will be active in business, education, the arts, religion, health care, government, community-based organizations, ethnic and minority groups and will reflect the diversity of the community.
  • Applicants must have the full support of the company or organization they represent, as well as their employer or supervisor. Attendance at the retreat and monthly meetings is mandatory. Those who fail to attend will not graduate from the program and will not receive a refund in tuition. Tuition for the Class of 2011 is $2,000 Chamber members and $2,300 for non-members.

Applicant Information
PERSONAL DATA
Last Name*
First Name*
Middle Name:
Name for Name Tag
Home Address*
City*
State*
Zip*
Home Phone*
Home E-mail
Business Address
City
State
Zip
Business Phone
Business E-Mail
Fax
Spouse Name
Children
OPTIONAL PERSONAL DATA
(this information is helpful in assuring a diverse class)
Sex
Date of Birth
Place of Birth
Race
Years lived/worked in region
.
EDUCATION
High  School
Name of School
From
To
Degree/Major
College  
Name of School
From
To
Degree/Major
Graduate
Name of School
From
To
Degree/Major
Continuing Education
Name of School
From
To
Degree/Major
EMPLOYMENT
Current Employer
Title/Responsibility
Start Date
Since
Previous Employer
Employer 1
Start Date
End Date
Title/Responsibility
Employer 2
Start Date
End Date
Title/Responsibility
Employer 3
Start Date
End Date
Title/Responsibility
INVOLVEMENT
Include athletic, business, civic, community, government, political, professional, religious, social, or other activities. Indicate major rolls in the organization at this time.
Organization 1
Responsibilities
Organization 2
Responsibilities
What do you consider to be your most important community service accomplishment date?
GENERAL INFORMATION
1. What do you hope to gain through your participation in Leadership Northern Kentucky and how would you plan to utilize this experience?*
2. What is the most significant leadership quality necessary to bring about positive change within the Region?*
3. What are the two most pressing issues facing Northern Kentucky and/or our Region today?*
4. Have you ever applied to Leadership Northern Kentucky before?* If Yes, what year
5. Will you need special accomodations because of a disability/diet?* If Yes, please descibe
6. What qualities do you feel you can bring to the success of the program?*
7. The program is a lot more fun than the application, so please provide some fun facts about yourself; nickname; favorite food; favorite trip; favorite book or movie.
REFERENCES
All applicants are required to submit three (3) confidential references. One reference must be your employer. References must be submitted using our online referral form. Personal letters of recommendation will not be accepted. The Chamber must receive this information by 5 p.m. on Fri. June 18, 2010. Please indicate those submitting references
Reference 1*
Phone*
Reference 2*
Phone*
Reference 3*
Phone*
TUITION
The tuition for Leadership Northern Kentucky must be returned with a check for $2,000 Chamber members, $2,300 non-members, no later than Fri. June 18, 2010. Class enrollees will be announced by Fri. July 9, 2010. Applicants not selected will have their payments returned shortly thereafter.
SCHOLARSHIPS
Limited scholarship funding is available.
If accepted, will you find it necessary to seek scholarship assistance towards the tuition fee, and if so, how much?
If Yes, Amount $ (not to exceed $1,900 Chamber members, $2,200 non-members) Assistance toward tuition fee Yes How Much
 
NOTE: Each scholarship recipient must pay or raise a minimum of $100.
COMMITMENT
  • Attendance at all sessions is required for graduation from the program. (One excused absence is allowed.)
  • Retreat (September 16 & 17, 2010). This requires an overnight stay.
  • Sessions are one full day per month, September through May, plus half day for Project Formation.
  • Monthly sessions run from 7:30 a.m. to 5:30 p.m. Block out the entire day on your calendar!
  • To graduate from Leadership Northern Kentucky, a participant is expected to attend all sessions.
  • Sessions (with preliminary dates) can be viewed online.

Please indicate your acceptance of this commitment by clicking the Apply button below. You are committing to attend all of the sessions, including the overnight retreat. You also realize that this commitment is for the entire day (7:30  a.m. - 5:30 p.m.) of each session.
Please click submit only one time.  The transaction may take several seconds.