2011 Las Vegas Leadership Program Application


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Leadership Las Vegas is an intensive, 10-month program devoted to strengthening and educating our community leaders. Leadership Las Vegas provides in-depth insights into a variety of issues impacting residents of Southern Nevada.

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2011 Las Vegas Leadership Program Application

  1. 1. Mission Statement: Leadership Las Vegas is dedicated to developing leaders committed to improving their community through service. Selection Criteria: Leadership Las Vegas seeks individuals who have: • a commitment to remain in the community and little likelihood of being transferred within the next three years • the commitment to allocate the time and energy necessary to complete the program with the full support of their employer • demonstrated commitment through past and present community involvement and/or an expressed desire for community involvement • demonstrated capacity for leadership within their own organizations through significant achievements • a sincere concern about the future of the Las Vegas community and a personal desire to help shape that future • thoroughly completed application LATE APPLICATIONS WILL NOT BE CONSIDERED The Leadership Las Vegas Class of 2011 will represent the demographics of the greater Las Vegas community. Finalists must attend a personal interview. Interviews will be scheduled between Monday, July 26, 2010 and Wednesday, August 11, 2010. All applicants will receive final written notification of their selection status by Monday, August 30, 2010. Name: • Type directly into this document. Click or tab to progress through the form. This PDF will not save so print the application when complete. Be sure to complete the “name” field at the top of this page. • Applications must be computer printed. Handwritten applications will not be accepted. Should you require assistance, please call the Leadership office at 702-641-5822. • Please limit answers to available space. • Print a hard copy of the completed application and obtain all required signatures. Keep a copy for your records. Applications may be submitted by: Email: lgough@lvchamber.com Fax: 702-735-0406 Mail: Leadership Las Vegas Las Vegas Chamber of Commerce, Ste 300 6671 Las Vegas Blvd S. Las Vegas, NV 89119 APPLICATION DEADLINE: 4:00 p.m., Wednesday June 2, 2010 LATE APPLICATIONS WILL NOT BE CONSIDERED Attachments and/or letters of recommendation are not permitted. Application Instructions: Class of 2011 Application
  2. 2. Have you lived in Las Vegas for more than two years? Yes No Are you a Focus Las Vegas Graduate? Yes No If ‘Yes’, enter year attended. How did you hear about Leadership Las Vegas? Recruited/Referred by: Chamber Publication/Function: Other (Please Specify): Biographical Data Prefix: Mr. Mrs. Ms. Dr. First Name: Middle Name: Last Name: Preferred First Name/Nick Name (Badge): Position/Title: Company Name: Company Address: City: State: NV Zip: Company Phone Main: Company Phone Direct: Company Fax: Cellular: E-Mail Address: Web site Address: Home Address: City: State: NV Zip: Home Phone: Home Fax: Home E-Mail Address:
  3. 3. Community Involvement 1. Have you volunteered time or participated in other community activities during the last five years? Yes No (If you answered ‘No’, please skip to #4.) 2. If ‘Yes’, please describe below. (Spell out acronyms the first time used.) Community Activity 1 Organization/Activity: Position/Role: Reference: Hours Per Month: Community Activity 2 Organization/Activity: Position/Role: Reference: Hours Per Month: Community Activity 3 Organization/Activity: Position/Role: Reference: Hours Per Month: 3. Please select at least one from those you listed above and briefly describe your involvement and the accomplishment of which you are most proud. Once completed, skip to #5. (maximum 600 characters) 4. Please tell us why you have not participated in the community. (maximum 600 characters) 5. Please describe the area(s) of the community about which you would like to learn more or become involved. (maximum 600 characters)
  4. 4. 6. Have you volunteered time with, or been a member of, any professional organizations during the past five years? Yes No (If you answered ‘No’, please skip to #10.) 7. If ‘Yes’, please describe below. (Spell out acronyms the first time used.) Professional Organization 1 Organization/Activity: Position/Role: Reference: Hours Per Month: Professional Organization 2 Organization/Activity: Position/Role: Reference: Hours Per Month: Professional Organization 3 Organization/Activity: Position/Role: Reference: Hours Per Month: 8. Regarding the above question, describe any significant impacts or contributions you may have made. (maximum 600 characters) 9. Describe leadership roles you have held professionally and/or personally. (maximum 600 characters) 10. Briefly define your view of leadership. (maximum 600 characters)
  5. 5. 11. What leadership skills do you feel you possess and how have others benefited from these skills? (maximum 600 characters) 12. What leadership skills do you have the desire to strengthen through this program? (maximum 600 characters) 13. Is there a person (either alive or deceased) who you consider a great leader? Why? (maximum 600 characters) Employment Information 14. Current/most recent employer and duration of employment. (maximum 600 characters)
  6. 6. 15. Employment history for the past ten years or past four employers. (maximum 600 characters) 16. List any special honors or awards you have received during the past five years. (maximum 600 characters) Other Information 17. Briefly describe anything else you would like us to know about you. (maximum 600 characters) 18. Briefly describe your understanding of the goal of Leadership Las Vegas. (maximum 600 characters) Completion of this section is voluntary and will not be included in selection process. Gender Male Female Race/Ethnicity African American Asian Caucasian Hispanic Multi-Racial Native American AGE 21-30 31-40 41-50 51-60 60+
  7. 7. CANDIDATE NAME: Please print this page. When the following sections are completed, initialed, and signed, fax to 702-735-0413 or mail to: Leadership Las Vegas, 6671 Las Vegas Blvd, South, Suite 300, Las Vegas, NV 89119. Statement of Commitment Please read carefully and initial each section. All required signatures must be obtained or application will not be accepted. Note: If applicant is his/her own employer/ financial sponsor, applicant must sign all signature lines Attendance The Leadership Las Vegas program consists of 10 scheduled sessions that include a two and one-half day, two- night opening session, and nine program days. To graduate from the program participants are expected to attend all sessions. The opening session is scheduled for September 30 - October 2, 2010. All other sessions (October 2010 through June 2011) are one full day per month, generally the second Friday of each month, from 7:30 a.m. until 5:00 p.m. Only individuals willing to make such a firm commitment should apply. Full participation is required. Homework and optional activities will involve additional time commitment. Absence from one session may be cause for dismissal from the program. To fully enjoy the learning and relationship building experience, cell phones, pagers, beepers, and other personal communications devices are not permitted at any session. On-site staff will have a cell phone for emergency use. The number will be provided at the start of the program. Initial: Tuition Tuition is $2750.00 for designated Las Vegas Chamber of Commerce members and $3500.00 for non-members of the Las Vegas Chamber of Commerce. Class members who join the Chamber of Commerce within six months of the program start will receive $250.00 credit toward membership. Tuition covers all program costs, including materials, meals, transportation, and room at the opening session. Individuals chosen for class participation must have full tuition payment to the Las Vegas Chamber of Commerce by September 27, 2010. Initial: Signatures I have read the application packet and understand the goals and commitment of the Leadership Las Vegas program. If selected, I will devote the time and resources necessary to complete the program. Though emergencies do arise, I understand that should I be absent from any session or part of a session, I may be required to withdraw from the program and my tuition will not be refunded. My signature below indicates my commitment to and understanding of the attendance and participation policies and tuition requirements. By accepting admittance to the program you grant permission to be listed in our online directory. Candidate Signature Print First & Last Name Title Organization Employers are valuable partners in the continued success of Leadership Las Vegas. By signing below I agree to pay $__________ of the tuition for the above applicant, if accepted. I understand tuition is non-refundable, and attendance is required at all sessions. I indicate my/our support of this application. In addition, if the applicant is selected for the Leadership Class of 2011, I will work with the applicant, his/her supervisor and/or team so that work assignments and business travel are planned to ensure attendance at each of the class days from September 2010 thru June 2011. Financial Sponsor Signature Print First & Last Name Title Organization Candidates for the Leadership Las Vegas program must have the support and commitment of their sponsoring business or organization. The signature of the head of the sponsoring organization is necessary as an indication of support of the candidate’s participation in Leadership Las Vegas. Employer Signature Print First & Last Name Title Organization