LEADERSHIP WARREN COUNTY Class of 2009
P.O. Box 802
Lebanon, Ohio 45036-0802
CONFIDENTIAL PROGRAM APPLICATION
LEADERSHIP WARREN COUNTY is a ten-month program sponsored by the Area Progress Council of Warren County, Inc. It is designed to identify,
educate, motivate and develop a select group of Warren County citizens for positions of leadership in our community. Participants are selected on the
basis of ability, leadership potential and demonstrated interest in the county .
PLEASE TYPE OR PRINT YOUR APPLICATION. CONCISE REPORTING IS IMPORTANT; DO NOT USE ANY
ADDITIONAL PAGES FOR THIS APPLICATION. BOTH APPLICANT AND EMPLOYER MUST SIGN APPLICATIONS.
1. PERSONAL DATA
Full Name Preferred First Name Date of Birth
Male/Female Spouse’s Name Years in Warren Co.
Home Address City ZIP Code Phone
Business/Organization Affiliation Position/Title
Business Address City ZIP Code Phone
Preferred Mailing Address (circle one) WORK___ HOME___ E-mail _____________________________________
Degrees received, school, years, field of study, professional programs, etc.
Present employment responsibilities. Describe your present position and how long you have held this position.
List in order of importance, your professional affiliations. Include any office, committee or leadership positions and the time of your
5. COMMITMENT TO THE COMMUNITY
A. List in order of importance those community groups, committees or boards in which you have been active. Indicate office,
committee or leadership positions and the time of your affiliation.
B. What attributes do you have that make you an effective community leader/trustee? Give specific examples of how you have
demonstrated these attributes.
C. Give a brief statement of your reason for desiring to participate in the LEADERSHIP WARREN COUNTY program. Explain what
you feel you can contribute to the program and to the county after completing the program.
D. What do you believe are the important issues facing Warren County?
LEADERSHIP WARREN COUNTY requires a serious commitment of time and energy.
Full participation of each individual is necessary and attendance at each session is expected. (More than a total
of 2 days absence will render the candidate ineligible for graduation with the class.)
Participation in the FULL opening overnight retreat is mandatory.
Participants will have assignments in addition to scheduled class sessions, occasionally for a full day.
o A. WILL YOU BE ABLE TO FULFILL THIS COMMITMENT? (mark one) YES___ NO___
Class projects will be an additional activity outside of class time.
o B. WILL YOU BE WILLING TO PARTICIPATE? (mark one) YES___ NO___
What do you hope to gain from the program and how do you expect to utilize your LEADERSHIP WARREN COUNTY
If you are selected to participate in the LEADERSHIP WARREN COUNTY program, and you or your company/organization is a
member of the Area Progress Council or any Chamber of Commerce in Warren County, your tuition fee is $1,700. The nonmember
tuition fee is $2,100. A limited number of partial scholarships may be available. If you wish to apply for aid, attach a separate sheet
stating the amount needed and reasons for your request. Program fees are deductible as a business expense, not as a charitable
Return this application to: LEADERSHIP WARREN COUNTY, Area Progress Council, P O Box 802, Lebanon, Ohio 45036-0802.
For more information, call: Bill Thornton at 513-265-0450, email@example.com, or Arla Tannehill at 513-932-8228,
firstname.lastname@example.org, FAX 513-933-8228.
Invoice for Tuition should be sent to: (PLEASE TYPE)
Address City ZIP Code
8. MEMORANDUM OF UNDERSTANDING
A. I understand the purpose of LEADERSHIP WARREN COUNTY; and that submission of this application does not ensure my
acceptance in the class. If I am selected to participate, I will devote the time necessary to attend each program session: Feb. 11 &
12, Feb. 26, Mar. 19, Apr. 16, May 15, Jun. 11, Jul. 13, Aug. 11, Sep. 10, Oct 6, Oct. 29 & 30, Nov. 24, 2009, and extracurricular
activities, and will pay my tuition. IF YOU HAVE A CONFLICT WITH THE OPENING RETREAT FEBUARY 11-12, 2009, PLEASE
DO NOT APPLY FOR THE 2009 COURSE.
B. This candidate has my full support to participate in Leadership Warren County. I am aware of the time commitment involved in
his/her effective participation as well as the financial obligation. (Signed by organization’s CEO, if other than applicant.)
ALL APPLICATIONS ARE SUBJECT TO CONFIDENTIAL EVALUATION