Application for Admission

A special strength of the Leadership Butler County program is the diversity of its class members. Each year, the class consists of individuals from the private, public and non-profit sectors. These men and women are active in business, labor, education, the professions, the arts, religion, human services, health care and other backgrounds.
Unlike many other professional development and training programs, the Leadership Butler County Program focuses on improving the quality of life in Butler County by providing executive skills with hands on visitation and touring of our countys greatest assets. This is a great opportunity for you to experience many facets of Butler County by taking part in the scheduled series of sessions using the non-typical, non-classroom approach. Many of the days involve outdoor physical activities which include team building skill exercises as well as walking and touring.

hank you for considering Leadership Butler County!

Please limit your responses to the available space on this form. Include a current resume or biographical profile with this application along with three (3) references. Final determinations regarding admission are made by the Leadership Butler County Board of Directors. The information provided with this application is considered during the review process. Class size is limited. Each of the sessions is held during normal business hours therefore applicants must have the full support of the business or organization they represent.
Our Mission: Leadership Butler County provides participants exposure to issues, resources and opportunities for service in the Butler County area; educating them on the concept of community leadership, teaching skills required of an effective community leader and ensuring that they become enlightened, contributing members of our community.
Leadership Butler County is an affiliate program of the Butler County Chamber of Commerce and works in partnership with Butler County Community College, Slippery Rock University, Butler County Tourism & Convention Bureau and United Way of Butler County.

Butler County's Only Leadership Development Program

Personal Information
Name (Last,First) ___________________________________________________________________________ Preferred Name Years you have resided / worked in Butler? Home Address City e-mail Have you ever participated in another community leadership program? If so, when? Where? State Zip Phone Fax

How did you learn about Leadership Butler County?

Employment
Present Employer Work Address City Employer Website Job Title and Responsibilities State Zip Since Phone e-mail Fax

List your previous employers, including military duty: Employer Title/Responsibility Period of Service

What professional awards/recognition have you received?

What do you consider your most significant achievement?

Education
(Start with the highest level attained and work back through high school.) Name of Institution Dates Degree Major(s)

Community Involvement
A. List in order of importance to you, activities in which you have been involved over the past five years, either civic, professional, athletic, social, religious, community or cultural. Organization Responsibility From To

Explain the reason for your commitment to your major volunteer role?

How much time do you commit to vounteerism monthly?

B. If you have not been involved in the community in the past few years, what has changed to make you seek involvement at this time?

C. What community activities do you see yourself involved with in the future?

D. One of the goals of Leadership Butler County is to build a network of community leaders who can enhance their problem-solving skills and other leadership abilities through shared perspectives and working together. 1. What do you feel are the three most challenging issues facing Butler County today? a) b) c) 2. What contribution(s) can you make to address these issues?

Community Involvement (continued)

3. What do you expect to gain from participation in the Leadership Butler County program?

Program Information
Tuition Tuition is $1500 per participant. The tuition includes sessions, guest lectures, materials, meals, transportation and other program essentials. Sponsors are encouraged to pay the tuition of their participants. A limited number of partial scholarships are available. If accepted to the program, is tuition assistance needed? Yes No Commitment A. Candidate: I understand the goals of Leadership Butler County and my commitment to the program. If selected, I will attend all the sessions/functions and devote the time necessary to be a contributing member of Leadership Butler County. Further, I understand that lack of attendance may cause removal from the program.
Candidate signature:

B. Financial Sponsor: I agree to pay $1500 tuition fee for the above applicant, if accepted. I understand tuition is non-refundable.
Financial Sponsor signature: Print Name, Title, Organization:

C. Employer: I agree to allow my employee, if accepted, to devote the time necessary to be an active member of the Leadership Butler County program.
Employer signature: Print Name, Title, Organization:

Please send completed application, three (3) references and resume to:

Leadership Butler County 101 E. Diamond Steet Morgan Center - Lower Level, Suite 116 P.O. Box 1082 Butler, PA 16003-1082 724.283.2222 fax: 724.283.0224 Visit us at ButlerCountyChamber.com e-mail: Jennifer@ButlerCountyChamber.com