2025 Signature Application

Leadership Lake County has provided leadership development programs since 1987. The experiential nature of our program days and the preparation for workplace and community leadership roles are the hallmarks of our programs. The Leadership Lake County Signature Program is our flagship program, designed for established professionals in preparation for leadership service within an organization and service on non-profit boards and as community leaders. The program runs September-May for a full day on the second Wednesday of each month.

Tuition $3,100 is due on August 1, 2024

Participants in Leadership Lake County, Inc. will be selected from applicants’ submissions. Please complete this form electronically. You will receive confirmation of receipt of your application within two business days. Browser needed: Google Chrome or Mozilla Firefox.

Application Due Date: May 31, 2024

First Name

Last Name

Name as it should appear on Nametag

Business Information

Business/Organization Name

Title/Position

Business Email

Business Phone

BUSINESS Address

Address Line 1

Address Line 2

City

Country

Select

State/Province

Select

Zip Code

Supervisor's Name

Supervisor's Name Title

Personal Information

Personal Email

Mobile Phone

HOME Address

Address Line 1

Address Line 2

City

Country

Select

State/Province

Select

Zip Code

Spouse/Partner Name

Birthdate (mm/dd/yyyy)

Demographic Information (for internal use only)

Sex

Select Gender

Female
Male
Trans
Prefer not to answer

Ethnicity

Select One

White
Asian
African American
Hispanic-Latino
Native American
Bi-Racial
Other

More About YOU

Name and City of High School

Graduation Date

Name of College

City of College

Graduation Year

Degree/Major

Name of College

City of College

Graduation Year

Degree/Major

Military Service - Branch/Dates

Civic Engagement History

Major volunteer roles at this time. Please include leadership positions where applicable.

Please list, in order of importance to you, other organizations you have volunteered for in the past.

Community Organizations/Non-Profits I am interested in serving

Employment History

Previous Employer Name/City

Dates/Title/Responsibility

Previous Employer Name/City

Dates/Title/Responsibility

Participation

In order to accomplish the program’s stated objectives, total attendance and full participation of each individual selected is necessary.

Participation includes:

*Orientation: August 28, 2024 from 4pm-5:45pm followed by a reception with our Board of Trustees and Alumni from 5:45pm-6:45pm

*Opening Retreat: September 18-20, 2024. Overnight Retreat at Punderson State Park

History Day l Leadership Lesson: Technical vs. Adaptive Challenges: October 9, 2024 from 7:30am-3:45pm

Education Day l Leadership Lesson: Diversity, Equity, & Inclusion: November 13, 2024 from 7:30am-3:45pm

Business, Labor, & Economy Day l Leadership Lesson: Energize Others: December 11, 2024 7:30am-3:45pm

*Midyear Retreat: January 22, 2025 from 8am-4:30pm

Health Care & Healthy Living Day l Leadership Lesson: Purposeful Experiments: February 12, 2025 from 7:30am-3:45pm

Public Safety, Justice, & Government Day l Leadership Lesson: Intervene Skillfully: March 12, 2025 from 7:30am-3:45pm

Environment Day l Leadership Lesson: A Shared Purpose: April 9, 2025 from 7:30am-3:45pm

Quality of Life Day l Leadership Lesson: Manage Self: May 14, 2025 from 8am-5pm followed by a family-friendly cook-out with alumni from 5pm-7pm at The Lake Erie Bluffs Shelter

*Closing Retreat l May 28, 2025 from 8:45am-12:15pm

*Graduation l May 28, 2025 from 5pm-9pm at St. Noel's Banquet Center

*Mandatory attendance required. We ask for 80% attendance overall to be eligible for graduation

Questions?

Reach out to Juliana Petti, Director of Professional Programs at JPetti@leadershiplc.org

Time Commitment

Will you be able to fulfill this time commitment?

Employer/Family Support

Do you have the full support of your employer/family for the time required to participate effectively in this program?

What three (3) goals would you hope to achieve from participating in this program?

Community Issues

In your judgement, what are the two most pressing issue facing Lake County today? Explain why and provide any recommendations you may have for resolving these issues. (Approx 250 words)

Tuition

Tuition Payment

There is a tuition requirement of $3,100. per participant in the Signature Program. Tuition is due August 1, 2024. How will your tuition be paid?

Employer
Personal

Dietary Restrictions - Please note any restrictions/allergies

Referred to Program by:

Commitment

I understand the purpose of the Leadership Lake County Signature Program and that completion of this application does not ensure a candidate's acceptance into the class. If selected, I will devote the time required to fulfill all obligations to the program. By entering my name is the box below, I am approving this as an authorized signature for my application.

First Name

Last Name

Date

Thank you for your application! The Board of Trustees approves the slate of candidates at the June Board Meeting. Applicants will be notified of her/his status by July 1, 2024. Non-refundable tuition payment is due by August 1, 2024.

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2025 Signature Application

Thank you for contacting us!