Full Name *
E-Mail *
Phone Number *
Address *
City *
State *
Zip *
Employer *
Job Title *
How long have you lived and/or worked in Ashland? *
How long do you anticipate being in the Ashland area? *
Professional Reference - Sponsoring Organization *
Personal Reference - Someone familiar with your community involvement *
Have you participated on any community boards, committees, or volunteer organizations? *
What are some of your hobbies and interests? *
What honors and special recognition have you received? *
What form of education have you received in the past? (degrees, training programs, certificates, etc.) *
Give a brief statement of your reason for desiring to participate in the Leadership Ashland program. Explain what you feel you can contribute to the program and to the county and its communities. *
What issues facing Ashland County and its communities would you like to explore? *
What kinds of county or community boards, committees or groups would you like to join in the future? *
To graduate from Leadership Ashland, participants must meet these attendance requirements:
Are there any of these time commitments you cannot meet?
Who will be responsible for your Leadership Ashland tuition? *
By checking, I understand that submission of this application does not guarantee participation in the program and I must be accepted into the upcoming Leadership Ashland Class, and receive confirmation as such before attending.
2 + 0 = ? Please prove that you are human by solving the equation *
