1. Page 1 of 3: Leadership Greater Augusta Application
How many years have you lived or worked in the Augusta region?
Employment Information
Current
Employer
Employed
Since:
Position Title:
Do you anticipate being
transferred in the next 3
years?
Yes
No
Responsibilities:
List previous positions (within 5 years, beginning with the most recent; include military duty):
Employer/Location Title/Responsibility
What do you consider your highest professional achievement?
Application Deadline: August 14, 2015
Notification of Acceptance: August 28, 2015
Use the “Tab” key to jump from one blank to the next. To answer a “yes” or “no” question, go to the correct one and click or hit the
space bar. If you need more room to answer, keep typing—the area will grow.
Full Name:
Last First M.I. Dietary Restrictions/Other
Accommodations?
Company name,
if applicable:
Street Address Apartment/Unit #
City State Zip Code
Work
Phone:
( ) ____
Mobile
Phone:
( ) ___
E-mail
Address:
________________________________
Education: List the education and training you consider significant:
School Name & Location Degree Awarded Major/Other Details

2. Page 2 of 3: Leadership Greater Augusta Application
How did you hear about Leadership Augusta? What is/are your reason(s) for applying?
Chamber e-blast
Chamber website
Newspaper
LGA Alumni
Chamber Newsletter
Co-worker
Chamber Ambassador
Other:
Learn more about the community
Engage in the community to make a positive difference
Learn and practice community leadership skills
All of the above
Other:
Open Answer Questions: Please answer the 2 questions below in the space provided. Please heed the limits, and do
not change the formatting (font, line spacing, etc.)
1. Describe one of your professional and/or personal ambitions. Explain what you hope to achieve and the benefits of
that ambition. What specific skills could Leadership Greater Augusta emphasize to help you achieve that goal?
(limited to ½ page)
Volunteer Activities and Community Involvement: With what significant activities have you been involved during
the last ten years that demonstrate your commitment to your community? Include work for schools, neighborhoods, political
campaigns, religious groups, cultural, athletic, professional and business activities:
Organization Date Title/Position or Responsibilities
Awards/honors:
Name Date Other Details

3. Page 3 of 3: Leadership Greater Augusta Application
2. What do you consider to be two significant challenges facing the Greater Augusta region today? Explain the
significance of these issues, from your perspective. (limited to ½ page)
A recommendation form is attached. Two letters of recommendation are required. One from your employer, preferably
immediate supervisor, and one from a community source who can explain how your background and experience would contribute
to the leadership class and why you should be considered.
Please complete the top half of the form with your personal information and deliver it to two (2) references, including a
stamped, self-addressed envelope for them to return the recommendation form to: Leadership Greater Augusta, P.O. Box
1107, Fishersville, VA 22939 by August 14. Or email to infoadmin@augustava.com
Please note: if recommendations are not received by August 14, your application will not be considered by the reviewing committee.
Applicant Agreement
I understand that Leadership Greater Augusta is a community leadership training and development
program, as well as a community leadership network coalition. Graduates of Leadership Greater Augusta
are expected to maintain involvement in the program and to continue to participate as leaders both in the
community at large and in Leadership Greater Augusta committees and programs. If selected to
participate, I agree to pay in full the nonrefundable tuition, commit the time required of the program (during
sessions as well as approximately 50 hours outside of sessions), and to meet the attendance and
professional decorum requirements. No refund will be given after August 28, 2015.
___________________________________________________ _________________
Applicant Name, serving as signature Date
___________________________________________________ _________________
Immediate Supervisor Name, if applicable, Date
Leadership Greater Augusta Attendance Policy
Attendance at all sessions is required for successful completion of this program.
 Participants who miss the Opening Retreat or Mid-Course Retreat will be suspended from the
program (with no refund).
 Participants are eligible for a certificate of completion if they have no more than two excused
absences. Absences for reasons of work, illness, and family emergency are considered
excused.
 Arriving late or leaving early is considered a half-session absence (with two such events the
equivalent of a full-session absence).
Submit application via email to: infoadmin@augustava.com
__________ Applicant must initial indicating they have read and understand the Attendance Policy