Leadership Tyler | Leadership Tyler Application

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Your Personal Information

Do you live or work in Tyler Texas?(Required)

Yes

Your Name(Required)

First Last

Your Preferred Email Address(Required)

Enter Email Confirm Email

Home Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Your best contact phone number(Required)

Your Birthday(Required)

Spouse's Name (If Applicable)

More information about yourself:

How long have you lived in the Tyler area?(Required)

Gender(Required)

Male

Female

Ethnicity(Required)

African American

Asian

Caucasian

Hispanic

Other

I do not wish to provide this information

Current Employment Information

Company Name(Required)

Your Job Title(Required)

Industry

Work Phone Number

Are you self employed?(Required)

If you select "Yes", you will be exempt from completing the Employer's Authorization/Commitment form. Please ONLY select "Yes" if you do not need any Employer authorization to participate in the Leadership Tyler program.

Yes

If you are self-employed and do not have a supervisor, please put in your own details below in the required fields and do not leave blank. Thank you!

Your supervisor's name(Required)

Supervisor's title(Required)

Supervisor's Email(Required)

Employer Authorization/Financial Commitment

Upon submission of this form, you and your supervisor will receive a link via email to the Employer Authorization/Financial Commitment form. This will need to be completed and submitted by your employer/supervisor (if applicable) for your application to be considered. Your employer will need to verify that they understand the time commitment required to participate in Leadership Tyler.

Company Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Duties and responsibilities:

Education/Community Information

Institution Name(s)

Degree(s) Received

Special awards, accomplishments, honors:

Volunteer Service:

Background Verification

Full legal name:(Required)

Have you ever been convicted of a felony?(Required)

Yes

If yes, when was the incident and what was the charge?

Verification of Information:

I certify that all information given in this application, supporting documents, and interviews is correct to the best of my knowledge. I understand that any false information, omissions or misrepresentation of facts may disqualify myapplication or result in a non-refundable dismissal from Leadership Tyler. I authorize Leadership Tyler to investigate all statements made on my application. This authorization shall be valid one year from application submission.

Authorization for a Background Check if Necessary:

I hereby authorize Leadership Tyler and/or its agents to investigate my background, references, character, employment, education, criminal or police records, for the purpose of confirming the information providedby me, which may be material to my qualifications for the Core Program for which I am applying I also understandthat I may withhold my permission and that in such a case, no investigation will be done, and my application forLeadership Tyler will not be processed further. I release Leadership Tyler and/or its agents and any person orentity, which provided information pursuant to the authorization, from any and all liabilities, claims, lawsuits in regards to the information obtained from any and all of the above referenced sources used.

Consent

I agree to the above verification and background check.

Your Signature(Required)

Your Name
Your Name
Your Name

Today's Date

Commitments for Participation

Financial Commitment Tuition for each participant in Leadership Tyler is $2,750, of which at least $150 must be paid by the participant personally. Financial assistance is very limited. For information on financial assistance, please refer to the Application for Tuition Assistance.

You may make adjustments to the first, third and fourth amounts below granted the total comes to $2,750.

1. Amount your employer is contributing:

2. Amount of your personal contribution (Minimum $150 required from applicant):

3. Amount of any assistance requested (enter $0 if none):

Leadership Tyler Financial Assistance - ONLY COMPLETE IF APPLICABLE

The policy of Leadership Tyler (LT) is to provide a limited amount of tuition assistance to those candidates who are accepted into the program and demonstrate a financial hardship that would otherwise prevent their participation. Applications for assistance are confidential and have no bearing on selection. Award amounts are based on the number of requests received and the amount of funds available for that year. Assistance will not be granted for the entire amount of tuition under any circumstances. Consideration for tuition assistance is based on demonstrated need. To be considered for tuition assistance, you must complete the following information.

Please provide your reasoning for your financial assistance below:

Time Commitment for Class 40

Our curriculum is designed to provide a continuous learning experience throughout the course of the program. Full participation is integral to ensure all class members fully benefit from the program, both for their individual personal development and for the contributions each member makes to the class. We have the following attendance requirements:

Participants in the Leadership Tyler Core Program may only miss up to 8 hours of program time. They may not miss either the opening retreat or the closing retreat.

I, as an applicant, understand and agree to these commitments. (Sign below)(Required)

Your Name
Your Name
Your Name

Complete Your Essay Questions

Answer the following questions to the best of your ability. You can save your essay answers here and return to themanytime before submission. However, it is always advisable to retain a backup copy of your essays offline.

Essay Question 1: How do you define civic/community involvement? What civic/community volunteer experience do you expect to be involved in within the next five years?

Please limit your response to 250 words or less.

Essay Question 2: How do you expect to utilize your Leadership Tyler experience? What unique qualities will you bring to a Leadership Tyler class?

Please limit your response to 250 words or less.

Essay Question 3: What do you see as an opportunity for change in the Tyler/Smith County area? Why? How could you be personally engaged in this opportunity?

Please limit your response to 250 words or less.

Essay Question 4: Discuss a time when you felt pressure to compromise an element of your personal integrity. How did you handle it?

Please limit your response to 250 words or less.

Leadership Tyler Application

Your Personal Information

More information about yourself:

Current Employment Information

Employer Authorization/Financial Commitment

Education/Community Information

Background Verification

Verification of Information:

Authorization for a Background Check if Necessary:

Commitments for Participation

Financial Commitment Tuition for each participant in Leadership Tyler is $2,750, of which at least $150 must be paid by the participant personally. Financial assistance is very limited. For information on financial assistance, please refer to the Application for Tuition Assistance.

Leadership Tyler Financial Assistance - ONLY COMPLETE IF APPLICABLE

Time Commitment for Class 40

Complete Your Essay Questions

Essay Question 1: How do you define civic/community involvement? What civic/community volunteer experience do you expect to be involved in within the next five years?

Essay Question 2: How do you expect to utilize your Leadership Tyler experience? What unique qualities will you bring to a Leadership Tyler class?

Essay Question 3: What do you see as an opportunity for change in the Tyler/Smith County area? Why? How could you be personally engaged in this opportunity?

Essay Question 4: Discuss a time when you felt pressure to compromise an element of your personal integrity. How did you handle it?

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