2008 - 2009 APPLICATION FORM

The objective of Leadership Lakeville is to provide opportunities for citizens to learn about Lakeville, to learn about leadership opportunities within the community and to develop leadership skills. Leadership Lakeville is a collaborative effort sponsored by the Lakeville Area Chamber of Commerce CVB & Lakeville Foundation, the Rotary Club of Lakeville, the Lakeville Area Public Schools, the City of Lakeville and (took out Hosanna) Community Action Council. The cost of the program is $495.

Please submit this application online by June 30, 2008 by filling in the fields below and selecting the Submit button. If you prefer to US mail your application instead, print a hard copy and US mail by June 20, 2008 to either:

Lakeville Area Chamber of Commerce 19950 Dodd Boulevard Suite 101 Lakeville, MN 55044

OR

Cindy Johnson Leadership Lakeville Program Coordinator 10781 Alberton Way Inver Grove Heights, MN 55077

For more information, please call Program Coordinator Cindy Johnson at 651-452-6859, or send her e-mail.

Please supply the requested information below,
then click the Submit button to submit your application.

Name:
Home Address:
City:
State:
Zip:
Home Phone:
Home Email*:
Work Position:
Employer:
Work Address:
City:
State:
ZIP:
Work Phone:
Fax:
Sponsoring Business or Organization (if applicable):

* = Required

In two paragraphs or less, please respond to each of the following:

• Explain why you are interested in participating in Leadership Lakeville
  

• Describe a professional or civic challenge you have undertaken.
  

• Identify two issues you feel are critical to the Lakeville area.
  

• In one sentence, write your personal definition of leadership.
  

• List 3 or 4 leadership skills you would like to develop.
  

Please submit a resume through e-mail or complete the fields below.

Program Schedule -- Second Thursday of the month, September through May. Program times will vary, with some sessions to include evening hours:

September 11, 2008 October 9, 2008 November 13, 2008 December 11, 2008

January 8, 2009 February 12, 2009 March 12, 2009 April 16, 2009 May 14, 2009

Commitment:

Have you discussed this with your employer (yes or no)? Yes No

I agree to actively participate and will attend each of the monthly sessions.
Agree Disagree

Signature of Applicant: (If applying online, type your name)

LEADERSHIP LAKEVILLE APPLICATION

EMPLOYMENT HISTORY: List employment history beginning with your current employment.

DATES	EMPLOYER	POSITION

What are your responsibilities in your current position?

EDUCATION: List undergraduate and graduate college in the order attended.

SCHOOL	MAJOR	MINOR	DEGREE

PROFESSIONAL, CIVIC, VOLUNTEER ORGANIZATIONS: List memberships, affiliations and/or participation.

Please enter the information on the left into this field:*