Leadership Burke Application Tuition is $600 for Chamber members and $850 for non-members. This fee covers all program expenses. Step 1 of 4 25% Name* First Last Profile PictureAccepted file types: jpg, gif, png, pdf, Max. file size: 32 MB.Birth Date* MM slash DD slash YYYY Gender Male Female Years you have lived in Burke County.Home Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Best Contact Phone Number*Spouse/Partner Name First Last Names/Ages of childrenEmployer* Date of employent* MM slash DD slash YYYY Business Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Business Phone*Email* Enter Email Confirm Email Job Title* Preferred Contact Method* Home Business Any food allergies? Please list three (3) prior employers, be sure to include: Employer Name | Job Title | From-To*Please list three (3) prior employers, be sure to include: Employer Name | Job Title | From-ToWhat do you consider your highest responsibilty, skill or career achievement?*ORGANIZATIONS AND ACTIVITIES Please list in order of importance to you, up to five community, civic, professional, business, religious, social, athletic, and other organizations of which you have been a member. Include Organization | Approximate Dates | Official PositionsRecognitions or Awards Please list any recognitions, awards, and/or certifications you have received from your company or other organizations.Education*High SchoolAssociates DegreeBachelors DegreeGraduate or Professional DegreeSome CollegeOtherIf you completed a college degree, please list your major. Are there particular leadership skills that you hope to gain from this program?How much time each month do you commit to community, civic, professional and other organizations and activities?Have you been as active in community, and other activities as you would like to be? If not, what have been the major barriers to your becoming involved?If you have previously not had the time or interest to become actively involved, what conditions have changed that now enable you to seek involvement in the community?Which local volunteer agencies/organizations would you like to participate in during the next 12 months?Have you ever participated in another Community Leadership Program? If yes, please specify which one(s).What leadership courses or seminars have you attended in the past 5 years?Please write a statement of why you wish to participate in Leadership Burke and what you hope to gain from the experience.Are you a registered voter? If no, please explainWhere do you see yourself in five years? Please list three (3) people who are knowledgeable about your leadership performance and potential. (Include Name, Address, Phone Number)*Selection Criteria* Applicant has read and understands Participants will be chosen for Leadership Burke based upon the information provided in the application. Consideration is given to leadership achievements, community involvement, overall accomplishments, recommendations from peers and employers, and the ability and interest in assuming additional leadership roles in the community. To successfully complete Leadership Burke, a participant must attend all sessions. Absences are excused only in the event of an emergency or extenuating circumstance. A participant who is unable to attend all sessions may be asked to withdraw from the program and no portion of the tuition will be refunded. It is important that an applicant have the full support of his/her employer to attend all sessions. Class Schedule* Applicant has read and understands The Leadership Burke Program year will consist of a two-day retreat, 7monthly full-day sessions, and an evening graduation program in October. The following dates are required for this program. They are required to attend from 8:00am until 5:00pm. March 19th and 20th-Learning Styles and Leadership Behaviors Days; March 25th -Historical/Arts/Tourism Day; April 22nd-Food/Agriculture Day; May 27th-Manufacturing Day; June 24th-Energy/Manufacturing Day; August 26th-Government/Economy Day; September 23rd-Health/Medicine Day; October 21st-Education Day The Graduation will be held the evening of October 22nd. Class members are expected to attend Graduation and will be allowed to bring a guest. Agreement* Applicant has read and understands I understand the time commitment required for participation in the program and I will be at the program for the days listed above. If I am selected to be a class member, I will pay my tuition by the date required and will attend ALL sessions and devote the time to this program as required. I understand that if I do not attend these full days could result in withdrawal from the program. If you are selected to be in the Class of 2020, you have been selected because you are leader. Leaders show up and are present to what they have committed to in their profession. You will be a representative of your company. Your presence is required. Payment Options*Credit CardPayPalCheckInvoice My EmployerOtherThere is a fee associated with Leadership Burke. Please select how you would like to pay for the course. Once we receive your application, you will then be sent the payment fee via your selected payment option below.
