Class Member Application Form

Leadership Dixie
Class Member Application

First Name

Last Name

Cell Phone

Work Phone

Street Address

City

State

Zip code

How many years have you lived in Washington County?

List your current employer

List your work experience from the past 5 years.

Have you applied to the Leadership Dixie program before?

Yes

How did you learn about this program?

What challenges does Washington County face that you would like to become more educated about?

What Community Leadership have you done in the past 5 years?

What other activities and accomplishments are you proud of?

What special qualities or qualifications do you have that will add to the diversity of the Leadership Dixie Program?

Upload recent headshot of yourself (Max 15MB)

Upload File

I have read and agree to the statements below: If selected as part of Leadership Dixie's class, you must commit to the following attendance requirement: To be eligible for graduation from Leadership Dixie a participant must attend the initial Retreat Day (in August) and may not miss more than any portion of two (2) challenge days Held monthly from September through May. Except in truly unavoidable situations, punctuality and maintaining a presence for the entire session is required. Leadership Dixie participants are encouraged to share their experiences with others and to invite others to apply for subsequent classes.

Thanks for submitting!

Leadership Dixie Class Member Application

leadership dixie

Leadership Dixie
Class Member Application