The Richland Area Executive Leadership Institute Application The Richland Area Executive Leadership Institute is an eight-month leadership intensive for C-suite executives who are looking to elevate their leadership and increase their impact on their organization and the community. This institute incorporates the BetterCulture Mindset Leadership Program and will be facilitated and led by Greg Timberlake, Psy.D. This program has been designed with an executive’s busy schedule in mind, while still providing a robust and relevant experience that will result in a measurable increase in the ability to elevate organizational culture, strengthen community impact, and lead with clarity and intention. Applications for the 2026–2027 cohort are due by Friday, June 26, 2026. You may save drafts of your application as you work. Contact InformationPlease tell us how to contact you about program details.First Name *Last Name *Preferred NamePersonal Email *Mobile Phone *Home Address *City *State *Zip Code *Emergency ContactPlease tell us who to contact in case of an emergency.Emergency Contact Name *Emergency Contact Relationship to You *Emergency Contact Phone *OrganizationTell us about the organization you will be representing during Executive Leadership.Organization name *Organization Address *City *State *Zip Code *Work Email *Work Phone *LinkedIn ProfileTitle *Briefly describe your responsibilities. *How many years have you served in this role? *Number of employees at your organization: *select1-56-2021-5051-100100+Not applicableIndustry *selectAdvertising & MediaAgriculture, Fishing & ForestryArts, Culture & EntertainmentAutomotive, Marine & RVBusiness & Professional ServicesComputers & TelecommunicationsConstruction Equipment & ContractorsFamily, Community & Civic OrganizationsFinance & InsuranceHealth CareHome & GardenGovernment, Education & IndividualsIndustrial Supplies & ServicesLegalLodging & TravelManufacturing, Production & WholesaleNonprofitPersonal Services & CarePublic Utilities & EnvironmentRestaurants, Food & BeveragesSports & RecreationPets & VeterinaryReal Estate, Moving & StorageShopping & Specialty RetailTransportationOtherProfessional and Civic LeadershipTell us why you are applying for Executive Leadership. How will you contribute, and what do you hope to gain from the program?What leadership mindset or behavior do you most want to strengthen this year, and how do you see it influencing your team or organization? *As you consider Richland County’s future, where do you believe executive leaders have the greatest opportunity to create meaningful, long‑term impact? *CommitmentParticipants should plan to be present for every session to gain the full value of the program. To qualify for a certificate, individuals may miss only one session. Second Fridays, September through April, from 7:30 to 9 a.m. September 11, 2026 – Principle 1: Mission, Culture & Excellence October 9, 2026 – Principle 2: Pride November 13, 2026 – Principle 3: Growth December 11, 2026 – Principle 4: High Standards January 8, 2027 – Principle 5: Decisions February 12, 2027 – Principle 6: Conflict March 12, 2027 – Principle 7: Fun April 9, 2027 – Live Virtual Wrap-up Session with Kim Hoogeveen, co-founder of BetterCulture Will you be able to fulfill this time commitment? *YesNoTuitionTuition for Executive Leadership is $1,750.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 Executive Leadership 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 July 31, 2026.Signature *Start signing your signature hereYour browser does not support e-Signature field. SubmitSave as DraftPlease do not fill in this field.