Form | Leadership St. Tammany

PERSONAL INFORMATION
First Name*
Middle Name*
Last Name*
Nick Name
Gender*
- Male
- Female
Race
Birthdate*
Home Address*
Street Address City ZIP Code
Email Address*
Years in St. Tammany Parish*
Please enter a value between 1 and 99.
Home Phone Number*
Mobile Phone Number*
Spouse’s Name
Children*
How Many are Under 18?
Have you ever served in the Military?*
Dates Served*
From
*
to
Highest Rank*
Emergency Contact Name*
Emergency Contact Number*
Photo*
Accepted file types: jpg, gif, png.
Upload a photo of your self. Please limit the file size to 500k or less.

Upload in jpeg format.

EMPLOYMENT
Present Employer*
Date Hired*
Mailing Address*
Street Address Address Line 2 City State ZIP Code
Business Phone*
Business Fax*
Business Email*
Present Title*
Since*
Preferred mailing address*
Previous employment in reverse chronological order*
Employer Title/Responsibility From To

EDUCATION
Briefly summarize your educational background. Optional. List degrees/certificates received, field of study, vocational training programs, professional institutes, etc. List extracurricular activities and special honors received.

ORGANIZATIONS / ACTIVITIES / INVOLVEMENT
Please list volunteer organizations of which you have been a member and that have been of significance to you.*
Organization Position(s) Held Describe Responsibilities How much time each month do you commit to this organization?
COMMUNITY INVOLVEMENT
What do you consider your most important accomplishment in one of the above organizations? If you have not had the time or interest to become actively involved, what conditions have changed that now enable you to seek involvement in the community?*
COMMUNITY NEEDS
In your judgment, what is the most pressing problem facing St. Tammany Parish today?*
Why do you want to attend Leadership St. Tammany?*
Briefly describe a leadership challenge you have experienced or handled.*
Any added comment?

COMMITMENT
To graduate from Leadership St. Tammany, a participant is expected to attend all of the sessions. No more than 9 cumulative hours can be missed. If more than 9 hours are missed, you will be required to make it up the following year. Missing 27 or more hours will disqualify participants from making up the missed sessions and completing the program. Graduates will receive a certificate of completion upon meeting program requirements.
- Participation at the opening weekend retreat is mandatory for participation in the program. Attendance at the entire retreat is required.
- One full-day (9 hour) session per month, September through May, usually the second Wednesday
- The closing session is for four hours on an evening in May
Will you be able to fulfill this commitment?*
Do you have the support from your employer for the time involved?*
Please provide your supervisor’s contact information
Who recommended Leadership St. Tammany to you?
How did you hear about Leadership St. Tammany?
Have you previously applied to Leadership St. Tammany and when? (May be multiple years)
Tuition for each participant is $1,250. $100 is required with this application form. (This is refundable if not selected) Note: At least $100 of the tuition is required to be paid personally by the participant.
Will you be able to fulfill this financial commitment?*
A limited number of partial scholarships are available. If accepted to the Leadership St. Tammany Program, will you find it necessary to seek financial assistance from the Program toward the tuition fee?*
I understand the purpose and commitments of the Leadership St. Tammany Program; and, if I become a participant, I will devote the required time. I understand that more than nine cumulative hours of absences will mean that I will not graduate with my original class. The missed session(s) can be made up the following year, and a certificate will be received at the end of that year.
Signature*
Date*

Application Fee
Upon clicking submit below you will be taken to Paypal to process the $100.00 application fee.

Applicants who do not pay the $100.00 application fee will not be considered.

The application fee will be refunded if you are not selected.
Leadership St. Tammany Application Fee
Price: $100.00
Email
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Application Form

Step 1 of 6

PERSONAL INFORMATION

EMPLOYMENT

EDUCATION

ORGANIZATIONS / ACTIVITIES / INVOLVEMENT

COMMUNITY INVOLVEMENT

COMMUNITY NEEDS

COMMITMENT

Application Fee

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