First Name (required)
Last Name (required)
Employer (required)
Position (required)
Business Address (required)
City (required)
State (required)
Zip (required)
Home Address (required)
Mobile Phone (required)
Email (required)
Do you have a financial sponsor for the program tuition? YesNo
If you have a sponsor, please list: (required)
If you do not have a sponsor and would like to be considered for a partial scholarship, please explain need below.
How many years have you lived and/or worked in Hancock County? (required)
EDUCATION - Include trade schools and other specialized training and/or education
PERSONAL/PROFESSIONAL ACHIEVEMENT - List your highest responsibility/skill/career achievement.
COMMUNITY SERVICE - List any current community service activities in which you are involved and the amount of time you spend on these projects each month.
EXPECTATIONS - If given the opportunity, what community service activities would you like to support?
What do you hope to gain from your participation in the Leadership Legacy Program?
By checking this box, I am indicating that my employer and I understand the program requirements and agree to meet them.
