Leadership Geauga · 2023 Heritage Program Application

Contact Information

Name

*

First Name

Last Name

Email

*

Verify Email

*

Address

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Preferred First Name for Permanent Name Tag

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Phone

*

Relationship with Leadership Geauga

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Employment Status

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Job Title (For Publication)

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If you chose #1 or #2 above in the Employment Status section, please indicate your preferred title and company for publication on our website, in press releases, and in the graduate directory. This company name will also be used on your name tag when you attend Leadership Geauga events. In the case of those retired and now consulting, you might enter "President" for your job title, and "Jones Consulting" for your company.

(OPTIONAL) Company (For Publication)

(OPTIONAL) Submit a Current CV or Resume to Describe Career Highlights and Community Involvement

(OPTIONAL) Upload a current headshot photo

Title (Pre-Retirement)

*

Company (Pre-Retirement)

*

Business Address

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Home Email

Verify Email

Mobile Phone

Spouse or Partner's Name

First Name

Last Name

Date of Birth

*

(mm/dd/yyyy)

Gender

*

What strengths, skills, experience, or leadership would you bring to the Heritage Program Class of 2023?

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What about Geauga County do you most appreciate and value? What leadership book would you recommend that you enjoyed, or one that has helped shape your outlook as a leader? What is your favorite leadership empowerment quote? What has inspired or motivated you to become involved in your community? What is your favorite leadership or diversity quote?

Please provide a one-paragraph biography describing your career, experiences, and skills. This will be shared with other Heritage Program participants in a class handbook and will be provided to class instructors, nonprofits, and other agencies

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Commitment to Heritage Program Attendance

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I understand that participation in the Leadership Geauga Heritage Program requires a commitment to attend each of the program days (7 days) in their entirety. Missing more than one program day (or equivalent hours) could result in dismissal from the program. Please review the program day dates and mark them on your calendar.

Commitment to Group Work

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I understand that the Heritage Program involves group work, which will take place outside of the program days. It is hoped that each Heritage Program participant will be inspired to participate in at least one project, and active participation in the project following graduation, is requested. The time commitment for group projects will vary by project and the individual's project preference.