Leadership Lafayette Application

Application deadline Friday, December 6th, 2024, at 5 pm. Please review the tentative schedule for 2025. All sessions are from 8:30 am until 5 pm, unless otherwise noted. Consult your calendar for availability and confirm below before proceeding: 1/16/25 Orientation Part I (Mandatory) 1/23/25 Orientation Part II (Mandatory) 2/6/25 Community Service and Project Management 2/18/25 4-6 pm Projects and Mentorship Meeting 3/6/25 Community and Economic Development 4/3/25 University Community and Ole Miss Athletics 5/1/25 Government and Criminal Justice 6/5/25 Education and Schools 7/10/25 Business and Industry 8/7/25 Health and Wellness Community 8/28/25 5:30 – 8 pm Graduation (Mandatory)

Personal Information

Your Name(Required)

First Last

How would you like to be addressed?(Required)

This can include preferred pronouns, preferred name, etc.

Address(Required)

Street Address Address Line 2 City ZIP Code

Your Email Address(Required)

Cell Phone(Required)

How long have you lived/worked in Lafayette County?(Required)

Are there any accommodations you might need in order to fully participate in this program?

eg. vegetarian, wheelchair accessible, assistive technology, etc.

Employer Info

Employer Name(Required)

Employer Address(Required)

Street Address Address Line 2 City ZIP Code

Work Phone(Required)

Your Job Title/Position(Required)

Upload Your Resume(Required)

Accepted file types: jpg, pdf, doc, docx, Max. file size: 256 MB.

Upload One Professional Letter of Recommendation(Required)

Accepted file types: jpg, pdf, doc, docx, Max. file size: 256 MB.

A supervisor, co-worker, or civic leader would be great here

Questions & Details

Please give a personal statement regarding why you would like to be a part of Leadership Lafayette. No more than 250 words.(Required)

Tell us why you would be a good fit for Leadership Lafayette.(Required)

How have you been involved in your community?(Required)

What do you hope to gain from the Leadership Lafayette program?(Required)

What specific qualities, experiences, or skills do you possess that make you a stronger candidate for this program compared to others? Please explain why you would be the best choice for this opportunity.(Required)

Describe a time when you took the lead to solve a problem. This could be in a work setting, a volunteer role, or your personal life.(Required)

How did you hear about Leadership Lafayette?(Required)

Tuition for the Leadership Lafayette Program is $500. If accepted into the program, tuition must be paid prior to the first session. Please indicate your source of payment(Required)

Non-profits and individuals may qualify for 1/2 scholarship funding. Limited scholarships available.

In order to successfully complete and graduate from Leadership Lafayette, your FULL participation is required. You will be REQUIRED to attend monthly sessions and actively participate in a group project. YOU CANNOT MISS MORE THAN ONE (1) SESSION (or two 1/2 sessions). Please check all the boxes that apply.(Required)

Do you have the support of your employer for the time required to participate in this program? Please review the tentative dates and times of the proposed sessions at the top of this page.

Do you AND your employer understand that you will need to participate in a community project outside of the regularly scheduled class times?

Active participation in the community project (including discussion, participation, planning, implementation, etc.) outside of scheduled class times with Leadership Lafayette is expected of all participants.

Hours participation with the community project may vary and is often contingent upon the type of project selected. It is reasonable to expect to spend no less than 8-10 hours per month engaging with your community project. Will you be able to fulfill the commitment to the program?

I UNDERSTAND THE IMPORTANCE OF THIS COMMITMENT AND AGREE TO ATTEND ALL SCHEDULED SESSIONS AND ACTIVELY PARTICIPATE IN THE REQUIREMENTS OF THE PROGRAM.

Signature(Required)

First Last

By typing your name below, you are signing this form.