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Leadership Greater Jackson (LGJ)
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LGJ Application
Step 1 of 7 - Profile
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FULL NAME
*
First
Middle
Last
PREFERRED NAME
Please write how you would prefer your
Full Name
to be listed
Preferred EMAIL ADDRESS
*
This is the primary way we will contact you.
USER NAME
*
Your username will not be active unless you are accepted into Leadership Greater Jackson
HEAD SHOT (not required)
Upload an optional headshot for your profile. You can always add this after you have been accepted to Leadership Greater Jackson.
GENDER
*
Male
Female
Non-binary/third gender
PLACE OF BIRTH
*
AGE
*
RACE
*
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Other
YEARS IN JACKSON METRO AREA
*
HOME ADDRESS
*
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
HOME PHONE
CELL PHONE
*
SPOUSE/PARTNER NAME
First
Last
SPOUSE/PARTNER OCCUPATION
NUMBER OF CHILDREN
Select Number
0
1
2
3
4
5
6 or more
Have you applied for Leadership Greater Jackson in the past?
*
Yes
No
Can't remember
Were you a member of Youth Leadership Jackson (YLJ) in the past?
*
Yes
No
Can't remember
Have you or do you currently serve in any branch of the U.S. military?
*
Yes
No
If yes, please list the highest rank obtained during your service.
Sponsor:
May be your employer or an organization such as Junior League, Rotary, etc. If no sponsor, skip or write n/a.
PREVIOUS/CURRENT EDUCATION
*
Begin with high school, then college(s), business or trade schools and/or other specialized training.
Name and City/State of School
Dates (From-To)
Degree/Major
Special Awards for Academic Performance (if applicable)
EXTRACURRICULAR ACTIVITIES
Leadership positions held, special honors and awards received during the school years.
PRESENT EMPLOYER
*
TITLE
*
HIRE DATE
*
Date Format: MM slash DD slash YYYY
How long have you been in your current position?
*
INDUSTRY
*
Accounting/Finance
Advertising/Public Relations
Aerospace/Aviation
Arts/Entertainment/Publishing
Automotive
Banking/Mortgage
Business Development
Business Opportunity
Clerical/Administrative
Construction/Facilities
Consumer Goods
Customer Service
Education/Training
Energy/Utilities
Engineering
Government/Military
Green
Healthcare
Hospitality/Travel
Human Resources
Installation/Maintenance
Insurance
Internet
Job Search Aids
Law Enforcement/Security
Legal
Management/Executive
Manufacturing/Operations
Marketing
Non-Profit/Volunteer
Pharmaceutical/Biotech
Professional Services
QA/Quality Control
Real Estate
Restaurant/Food Service
Retail
Sales
Science/Research
Skilled Labor
Technology
Telecommunications
Transportation/Logistics
Other
BUSINESS ADDRESS
*
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
BUSINESS PHONE
*
Briefly describe your current roles and responsibilities in this position:
BUSINESS/PROFESSIONAL AFFILIATIONS
List any business or professional affiliations (not including civic organizations, public office or political activities).
Name of Group
Positions Held or Assignments
From
To
PREVIOUS EMPLOYMENT
Please list all previous employment in reverse chronological order (including military active duty)
Employer
Title or Responsibility
From
To
ACHIEVEMENT
*
What do you consider your highest career achievement to date?
COMMUNITY INVOLVEMENT
List any significant community, civic, religious, political, government, social, athletic or other activities that you participate in (do not include business/professional activities).
Organization
Assignment/Position
Describe Responsibilities
CURRENT VOLUNTEERING
*
How much time each month do you commit to volunteer work?
OTHER INVOLVEMENT (if applicable)
If you have additional significant community, civic, religious, political, government, social, athletic or other area of active involvement, please list below.
What do you consider your most important accomplishment in one of the above organizations? Why?
*
FUTURE VOLUNTEERING
*
What kind of volunteer activities would you like to become active in the future?
WHAT HAS CHANGED?
*
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?
THREE SIGNIFICANT PROBLEMS
*
What do you feel are the three most significant problems facing the greater Jackson area today? (Use as much space as you need.)
POSSIBLE SOLUTIONS
*
What do you feel needs to be done about one or more of these issues? (Use as much space as you need.)
THREE NOTABLE OPPORTUNITIES
*
What are three most notable opportunities the Greater Jackson Area has to offer? (Use as much space as you need.)
Why do you think you should be selected for Leadership Greater Jackson?
*
WHAT DO YOU HOPE TO GAIN
*
What specific skills/knowledge do you hope to gain from you participation in Leadership Greater Jackson?
ATTENDANCE REQUIREMENTS
*
Each participant is expected to commit to attending
ALL
Leadership Greater Jackson sessions. Participants must notify the LGJ Board of Directors or Program manager immediately, if unable to attend.
Participants who miss
ANY
mandatory session and/or who have more than 8 hours of total absences should expect to be asked to withdraw from the program with no refund.
The following sessions are considered mandatory sessions:
1.
Orientation
— The first class meeting to go over rules and proper procedures for the class, as well as, class pictures. Typically lasting approximately 2 to 2.5 hours.
2.
Opening Retreat
— The first official class session, this is a one and one-half day, out-of-town overnight session.
3.
Cultural Differences
— Two day, session is held locally.
The remainder of all program meetings listed on current class class agenda.
Additionally, program participants will work on community service projects in addition to their time in the leadership program.
Do you understand the purposes of the Leadership Greater Jackson program and acknowledge that if you are selected that you agree to devote the time and resources necessary to complete the program? Additionally, do you acknowledge that if you miss more than 8 hours or a mandatory session, you may be required to withdraw from the program and no portion of the tuition being refunded.
YES. I understand the above commitments and agree to be bound by signing or electronically submitting this application.
NO
TUITION
*
If accepted into the Leadership Greater Jackson program, you or your employer/sponsor will be billed for the tuition fee ($2,500) which covers all program costs, including room and meals at graduation and the opening, mid-year, and closing retreats.
Will you or your employer/sponsor pay the tuition fee ($2,500)?
YES - My Employer/Sponsor will pay the tuition fee
NO - I will pay my own tuition fee
DIETARY RESTRICTIONS
The tuition fee includes meals, should you be chosen for the program, do you have any dietary restrictions that we need to know about or try to accommodate? If so, please list or explain.
Statement of Understanding
*
I understand the above commitments and agree to be bound by them in submitting this application.
I understand that the Leadership Greater Jackson board of directors selects participants in such program based on a variety of considerations. Accordingly, I agree that Leadership Greater Jackson shall in no way be liable to me in the event I am not selected for participation in the program. Furthermore, Leadership Greater Jackson shall not be responsible or liable to me for any claim I might make based on my participation in the Leadership Greater Jackson program, should I be accepted and participate.
YES. I understand the above commitments and agree to be bound by signing or electronically submitting this application.
No
Email
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