Class Application- Virtual Track

Leadership Dixie
Class Member Application
VIRTUAL Track

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

Upload supported file (Max 15MB)

I have read and agree to the statements below. If selected as part of Leadership Dixie's Virtual Track class, I commit to adhering to the Core Values outlined on the Leadership Dixie website. I understand and accept the following requirements: To be eligible for graduation from Leadership Dixie, I must participate in the initial Retreat Day in August and attend all nine (9) virtual challenge days held monthly from September through May. I acknowledge that each challenge day includes mandatory participation within a designated time frame, along with required homework and additional engagement. I also commit to sharing my Leadership Dixie experience with others and encouraging them to apply for future classes.

Thanks for submitting!

Leadership Dixie Class Member Application VIRTUAL Track

leadership dixie

Leadership Dixie
Class Member Application
VIRTUAL Track