Leadership Southlake Application

 Personal Data


Home Address

Business Address

Education (Major college, graduate school, business/trade school, and/or specialized training

Name and Location of School Dates (from-to) Degree Major


Business/Professional Affiliations (if any - not including civic organizations, public office, or political activities):

Name of Organization Position Dates (from-to)

Community Involvement

  1. List community, civic, religious, political, government, social, athletic, or other activities in which you actively participate.
    Please do not duplicate anything already listed. List most recent first:
  2. Name of Organization Position Dates (from-to)
  3. What do you consider your most important accomplishment in one of these organizations? Why?

  4. How much time each month do you currently commit to volunteer work?

  5. What kinds of community activities would you like to become involved with in the future? Examples include city council, school board, chamber board, Rotary, etc.

I understand the purpose of Leadership Southlake and, if selected, will devote the time necessary to complete the program. I understand that the full-day ropes course and participation in a community advocacy project are required elements in order to graduate. I will attend the monthly class sessions from August to May 2017 and understand that missing any more than two class sessions will result in failure to graduate from the Leadership Southlake program.