Engage Richland Application Engage Richland empowers early career individuals to grow as leaders, engage in their community, and receive mentoring. The program gives young professionals in any industry an opportunity to meet with leaders and decision-makers through business tours and discussions. Opportunities for civic engagement will be discovered. The program is facilitated in collaboration with Richland Young Professionals and incorporates the RYP mentorship program. Program days consist of leadership development sessions, business tours to address issues and opportunities in Richland County, and mentor meetings. Please complete the application below by August 23, 2024 to be considered for the class of 2024-2025. You may save drafts of your application as needed. Personal InformationPlease tell us how to contact you and who to contact in case of an emergecy.Full Name *Preferred NameFirst Name *Last Name *Personal Email *Mobile Phone *Home Address *City *State *Zip Code *Emergency Contact Name *Emergency Contact Relationship to You *Emergency Contact Phone *Experience and GoalsTell us why you are applying for Engage Richland. How will you contribute, and what do you hope to gain from the program?Engage Richland is designed for participants who live OR work in Richland County. Please select your status below. *I live in Richland County.I work in Richland County.I both live and work in Richland County.How many years have you lived in Richland County? *How many years have you worked in Richland County? *Briefly describe your interest in Engage Richland, what you hope to gain, and how you expect to utilize your program experience. *What does the word "leadership" mean to you? *Please give an example of an impactful use of leadership skills, either that you executed or that you observed in someone else. *OrganizationTell us about the organization you will be representing during the program. Engage Richland is open to organizations of all sizes and industries. An individual does not have to be employed with an organization to participate in LU. For those not representing their place of employment, having an affiliation such as board member or volunteer is recommended.Organization name *Organization Address *City *State *Zip Code *Title and Responsibilities *How many years have you served in this role? *Work Email *Work Phone *LinkedIn ProfileYour affiliation with the organization *selectEmployeeBoard memberMemberVolunteerElected officialOtherIndustry *selectManufacturingServiceProfessionalHealthRetailEducationNonprofitOtherNumber of employees at your organization: *select1-56-2021-5051-100100+Not applicableMentorshipThe Richland Area Chamber & Economic Development and Richland Young Professionals are collaborating to provide a mentorship within the Engage Richland program. Participants have the opportunity to connect with seasoned, high-level business leaders for six months of learning and discovery, all while providing mentees with a firsthand look at life and work in Richland County. Mentors and mentees in the program reflect the diversity of workplace offerings in Richland County such as small and large businesses, non-profits, healthcare, and education.What are your career goals? *What are your interests outside of your profession (e.g. golfing, gardening)? *Describe an ideal candidate for your mentor. *ReferencePlease list the names and emails of a professional reference. Your reference will be contacted to complete a reference form.Professional ReferenceName *Company *Email *Phone *CommitmentTo graduate from Engage Richland, a participant must meet attend all but one program day.Program Days take place on the following Thursdays from 1 to 5 p.m.: October 17, 2024 November 21, 2024 December 19, 2024 January 16, 2025 February 20, 2025 March 27, 2025 Will you be able to fulfill this time commitment? *YesNoDo you have the full support of your employer for the required time-off from your position? *YesNoNot ApplicableTuitionTuition for Engage Richland is $500.Who will pay your tuition? *My employer will pay my tuition.I will personally pay my tuition.My tuition will be paid through a combination of employer and personal funds.If accepted in the Engage Richland program, I would like to request a payment plan. *YesNoAt what frequency would you like to be invoiced?selectMonthlyQuarterlyDemographicsResponses in this section are not used to make program admission decisions. Responses are voluntary and used to measure a cohort's representation of Richland County.What racial or ethnic group(s) describe you? (optional)selectAmerican Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or Other Pacific IslanderWhiteOtherAge Range (optional)select18-2425-3435-4445-5455-6465-7475+Gender (optional)selectWomanManTransgender WomanTransgender ManNon-BinaryAgender/I don’t identify with any genderPrefer not to stateOtherPreferred Pronouns (optional)selectShe/her/hersHe/him/hisThey/them/theirsZe/hir/hirsXe/xem/xyrsVer/vir/visTe/tem/terE/em/eirsTo the best of my knowledge and belief, the information I have provided is true and accurate. I understand the purposes of the Engage Richland program and, if I become a participant, I will devote the time and energy necessary to make it a successful experience and will use this experience to develop my leadership skills in the community. You will be notified of acceptance by Sept. 20, 2024.Signature *Start signing your signature hereYour browser does not support e-Signature field. SubmitSave as DraftPlease do not fill in this field.