Adult Application

Application Form

Name of Applicant*

Prefix First Last

Primary Address*

Street Address Address Line 2 City State ZIP

Preferred Phone Number

Preferred Email Address*

Enter Email Confirm Email

Please provide an email that allows attachments, forms, and group emails.

Have you previously applied for Leadership Clarksville?*

Education

Formal Education*

Begin with High School, then College (s), business or trade schools and / or specialized training to include dates of attendance, degrees conferred, and majors.

Place of Present Employment

Job Title*

Place of Present Employment*

Work Address*

Street Address Address Line 2 City State ZIP

Date Began Present Employer*

Previous Employment*

Please list previous employers for five years with dates of employment and job titles or responsibilities

Organizations and Activities

Memberships*

Organization

Membership Dates

Positions Held

Please list, in order of personal importance, up to five community, civic, professional, business, religious, social, athletic, and other organizations of which you are or have been a member.

What have you accomplished in these areas that you think important? ***

(**a minimum of 30 words per response)

What does community service or civic engagement means to you? **

(**a minimum of 30 words per response)

Why do you feel it is important as a leader to address these concerns? ***

(**a minimum of 30 words per response)

General

How long have you lived in Montgomery County?*

If not a native, what made you choose Montgomery County as your home? ***

(**a minimum of 30 words per response)

What do you know about Leadership Clarksville?*

Would you be willing to serve on a committee requiring two evenings a month?*

Yes

No

Please choose a committee(s) that you would be interested in serving:*

Alumni Engagement

Fundraising

Public Relations/Social Media

Select all that apply.

Opportunity

What do you hope to gain from your Leadership Clarksville experience?*

In your judgment, what are the three most pressing concerns or needs facing Clarksville/Montgomery County today?*

Explain why and include specific recommendations for resolving the three issues you've listed above.*

Application Notes And Requirements

Name

First Middle Last

Indicate acceptance of terms above by typing full name (First, Middle, Last) and date of signature.

Date

Name

First Middle Last

Indicate annual dues acceptance by typing full name (First, Middle, Last) and date of signature.

Date

Letter of Recommendation

Please enclose a letter of recommendation from a Leadership Clarksville graduate: (include the name, employer, telephone, email, and relationship of the Leadership Clarksville graduate submitting the letter on your behalf.

Letter of Recommendation*

Max. file size: 100 MB.

Attach one page letter of recommendation digitally from recommender.

Additional References

Please submit the name of two additional references and their contact information.

Reference 1

First Last

Email

Phone

Reference 2

First Last

Email

Phone

IMPORTANT – Please attach your headshot!!!

Attach Headshot*

Max. file size: 100 MB.

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Comments

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Class of 2026 Application Period:

Feb 10 – May 10, 2025

Application Form

Education

Place of Present Employment

Organizations and Activities

General

Opportunity

Application Notes And Requirements

Letter of Recommendation

Additional References

IMPORTANT – Please attach your headshot!!!

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