Leadership Unlimited Application Leadership Unlimited (LU) develops individuals into effective business and community leaders. This community leadership program expands participants’ knowledge of the challenges and opportunities within Richland County through tours, activities, and discussions. The program develops community-minded leaders through leadership development training, community familiarization, and networking. Please complete the application below by March 29, 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 NamePersonal 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 Leadership Unlimited. How will you contribute, and what do you hope to gain from the program?Leadership Unlimited 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 Leadership Unlimited, what you hope to gain, and how you expect to utilize your program experience. *What makes you a compelling candidate for this program? Please consider your leadership experience and/or future plans and goals, both professionally and in the community. *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. *Please give your opinion of three significant opportunities and/or challenges facing Richland County. *Responses to this question will be used to shape the topics and discussions for program days throughout Leadership Unlimited.OrganizationTell us about the organization you will be representing during Leadership Unlimited. Leadership Unlimited 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 applicableReferencesPlease list the names and emails of three references. They will be contacted to complete a reference form.Current Supervisor (preferred) or Professional ReferenceName *Company *Email *Phone *Personal ReferenceName *Company *Email *Phone *Someone familiar with your community and leadership activities.Name *Company *Email *Phone *CommitmentTo graduate from Leadership Unlimited, a participant must meet these attendance requirements: Orientation - Wednesday, Aug. 21 from 4 to 6 p.m. (required, but could be made up if necessary) Overnight Retreat at Mohican Lodge & Conference Center: Thursday, Sept. 5 at 8 a.m. to Friday, Sept. 6 at 12 p.m. (This is the Thursday and Friday after Labor Day. Absence results in removal from the program.) One full weekday per month, the second Thursday, October through June from 9 a.m. to 4 p.m. (up to two absences permitted.) Planning sessions (time set at the convenience of the program planning committee) Graduation celebration on June 12, 2025 from 5:30 to 7:30 p.m. (strongly encouraged) 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 the Leadership Unlimited program is $1,500. Discounts apply for Catalytic Members of the Richland Area Chamber & Economic Development. A non-refundable deposit of $250 is due when the candidate returns the acceptance form. The remainder of tuition or is due by September 13, 2024, or participants may request a payment plan. A limited number of $500 scholarships are available. The need for tuition assistance is not a consideration for selection for the leadership program. Please make checks payable to Mansfield-Richland Area Educational Foundation and mail to 55 N. Mullberry St., Mansfield OH 44902.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 Leadership Unlimited program, do you wish to apply for Tuition Assistance? *YesNoPlease briefly describe how a $500 scholarship would enable you to participate in the program. Applicants who receive tuition assistance will be notified along with an admission decision.If accepted in the Leadership Unlimited program, I would like to request a payment plan. *YesNoAt what frequency would you like to be invoiced?selectMonthlyQuarterlyTwice (July and January)DemographicsResponses 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 Leadership Unlimited 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 May 17, 2024.Signature *Start signing your signature hereYour browser does not support e-Signature field. SubmitSave as DraftPlease do not fill in this field.