2018-19 Leadership Walton Application
RequiredRequired Question(s)
Required 1.
Please enter the information indicated below.

First Name:
Last Name:
Work Phone:
Email Address:
emailaddress@xyz.com
Address 1:
Address 2:
City:
State/Province
(US/Canada):
Postal Code:

Required 2.

Will you be able to fulfill this commitment? 

 

350 characters left.
Required 3.

Does your employer aware of your application?

 

350 characters left.
Required 4.

If applicable, has your employer authorized the required time commitment for participation in Leadership Walton?

 

350 characters left.
Required 5.

Company Name

 

350 characters left.
Required 6.

Company Address

 

350 characters left.
Required 7.
Company Phone Number
 

50 characters left.
Required 8.

Current Title/Position

 

350 characters left.
Required 9.

Type of Business

 

350 characters left.
Required 10.

Date of Hire

 

50 characters left.
Required 11.

Years in Position

 

50 characters left.
Required 12.

Website

 

50 characters left.
Required 13.

Briefly describe your duties

 

350 characters left.
Required 14.

Previous Employer

 

350 characters left.
Required 15.

Title/Responsibility

 

350 characters left.
Required 16.

Dates Employed

 

50 characters left.
Required 17.

Previous Employer

 

350 characters left.
Required 18.

Title/Responsibility

 

350 characters left.
Required 19.

Dates Employed

 

50 characters left.
Required 20.

What would you consider your highest responsibility, skill or career achievement so far?

 

1000 characters left.
Required 21.
What Organizations/Activities/Community Involvement have you participated in? List dates and positions held in each.
 

1000 characters left.
Required 22.
What do you consider to have been a highlight or major accomplishment associated with any of the groups/ activities mentioned?
 

1000 characters left.
Required 23.
Did You Receive Awards or Honors? Please describe.
 

1000 characters left.
Required 24.
Please list, in order of importance to you, up to three civic, business, religious, social, athletic, or community organizations not listed above in which you have been involved.
 

1000 characters left.
Required 25.
What do you expect to gain from your participation in Leadership Walton?


 

1000 characters left.
Required 26.
Describe what you consider to be the three most pressing issues facing the Walton Area.
 

1000 characters left.
Required 27.
What do you feel are the three biggest opportunities for the Walton Area?
 

1000 characters left.
Required 28.
Henry David Thoreau said, "Things do not change, we change". How do you expect to change as a result of the Leadership Walton experience and how would you like to see the Greater Walton Area change?
 

1000 characters left.
Required 29.
Tuition includes all course materials, assessments, supplies and refreshments and is $1,375 for employees of Walton Area Chamber members, or $1,675 for non-Chamber members. Tuition must be received by the Walton Area Chamber by September 15, 2018. Will you, your company, or a combination make the payment of the tuition fee?
 

50 characters left.
Required 30.
STATEMENT OF UNDERSTANDING I understand the purpose of Leadership Walton and if I am selected for the 2018-2019 class, I will devote the time and resources necessary to complete the program. I understand that there is an attendance requirement and if more than one (1) program sessions are missed regardless of the reason, that I may be dropped from the program and that no portion of the tuition will be returned. I also understand that I will be required to attend the mandatory two-day, overnight retreat in late September 2018 (DATE TBD) and a two-day trip to Tallahassee for the 2019 Legislative Session. Discounted room rates will be available at my expense for the Tallahassee trip. I also understand that I must participate in a mandatory conference call two weeks prior to the Leadership Walton retreat in September 2018. In addition, I'm to schedule at least monthly meetings with my mentor to complete the program. I understand that completion of this application does not guarantee a candidate's acceptance into the 2018-2019 class. All applicants will be notified if their application does not meet the requirements. Please type your full name if you agree to the statement of understanding.
 

50 characters left.
Required 31.
Date
 

50 characters left.
32.
Employer Commitment (If applicable) This application has the approval of this organization and the applicant has our full support which includes time to participate. I understand that there is an attendance requirement and if more than one (1) program session is missed regardless of the reason, that my representative may be dropped from the program and that no portion of the tuition will be returned. Please type name of organization.
 

50 characters left.
33.
Representative and Title
 

350 characters left.
34.

Date

 

50 characters left.