APPLICATION Application - Leadership Shelby Class of 2021 The Application for the Class of 2021 is now open. 2020-2021 Program Calendar This program is for Shelby County, Kentucky General InformationName* First Middle Last Are You Registered to Vote?YesNoAddress* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneEmail* Date of Birth MM DD YYYY Years residing/working in Shelby County?*Expected tenure in Shelby County*How did you hear about Leadership Shelby?*T-Shirt Size*SmallMediumLargeXLXXLEmploymentCurrent Employer*Position*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Previous EmploymentPositionDatesPrevious EmploymentPositionDatesAwards for Jobs PerformanceEducationList High School, College, Business or Trade Schools and Specialized TrainingName/City of SchoolDatesDegree/MajorName/City of SchoolDatesDegree/MajorName/City of SchoolDatesDegree/MajorCommunity InvolvementPlease list in order of importance to you, up to four community, civic, religious or social organizations of which you are, or have been an active member.Organization/ActivityDatesYour Role/PositionOrganization/ActivityDatesYour Role/PositionOrganization/ActivityDatesYour Role/PositionCommunity Involvement InformationHours committed each month to community involvement?Awards for community involvement?What do you consider your most important community service endeavor to date? Why?Written Interview QuestionsIn 75 words or less, please explain your goals if selected to participate in Leadership Shelby. In 100 words or less, identify a major challenge or opportunity facing Shelbyville/Shelby County in the next five years. How would you, as a community leader, address this issue? Upload the files with your answers.Upload your Files*Accepted file types: doc, pdf, jpg, docx.Letters of RecommendationPlease upload TWO letters of recommendation belowLetter of Recommendation 1*Letter of Recommendation 2*Signed Calendar*Scholarship Assistance SectionPlease enter in the box below in 200 words or less the reason for your request and the amount requested. No more than $500 may be awarded. CommitmentTo graduate from Leadership Shelby, participants are expected to attend each monthly session for the full day. (Two excused absences may be permitted.) Our opening retreat is overnight and the closing retreat is a one day out of town meeting. Attendance of both retreats is mandatory. There are no exceptions. Applicants selected for Leadership Shelby will be billed for the $550 non-refundable tuition payable no later than July 31st. If selected I will devote the time and resources required to fully participate in the program. I understand if I am absent from more than two sessions, I will be required to withdraw from the program and my tuition will not be refunded. The signatures below indicate mine and my employer’s commitment to the application, attendance and tuition requirements. Late or incomplete applications will not be considered. Applicants will be notified by email of their acceptance by June 15th. It is your responsibility to remit the $550 tuition which must be received by Leadership Shelby no later than the July 31st deadline. If you are a scholarship recipient and do not complete the program you will be required to reimburse the Leadership Shelby scholarship fund.Application Fee Price: $20.00 Initial To Accept*CommentsThis field is for validation purposes and should be left unchanged. Save and Continue Later This iframe contains the logic required to handle Ajax powered Gravity Forms.