B.E.S.T. Leadership Application

First Name *

Last Name *

Preferred Name for Badge *

Birthdate *

Place of Birth *

Home Address *

Cell Phone *

Email *

If married, spouse's name:

Prefered means of Communication *

Phone

Text

Email

Preferred Mailing Address *

Home

Business/Organization

Name of Business/Organization *

Business/Organization Phone *

Business/Organization Address (with zip code) *

Job Title *

Primary Occupation *

Describe your primary occupation and duties, if applicable.

Previous Employment *

Provide your previous employment history.

Volunteer and Civic Engagement *

Describe your volunteer, civic, and community activities during the past five years, noting any special awards and citations.

Education *

Outline your education history, from primary through highest level achieved.

Interests in the Program *

Why are you interested in being part of the Leadership Program?

County & Community Needs *

Identify two local issues you feel need attention.

Program Relevance *

Which aspects of our curriculum are of greatest interest to you? Please share your opinions and expectations.

Expectations *

Please describe the outcomes you expect from your involvement in the leadership program.

Headshot *

Please include a headshot with your application submission.

20MB max

Guidelines and Logistics *

Your application cannot be considered until all requested information and a headshot have been received. All classes are limited to 20 participants. Application submission does not guarantee placement in the class. In the event more than 20 applications are received, a panel made up from representatives of the 3 area chamber will select participants to ensure the class reflects the diversity of the participating communities.

By submitting this application, I acknowledge that attendance at Session 1 is mandatory and that more than one absence will result in disqualification from graduating with this year’s class.

 Please make all checks payable to: Chamber Foundation of Bastrop County

Checks can be sent to: Bastrop Chamber of Commerce | 927 Main Street, Bastrop, TX 78602

All questions on this application are meant to ensure diversity, not to limit participation.

How will your tuition be handled?

My organization is prepared to cover tuition if I am accepted. ($800 until July 31 & $850 after that)

I will assume responsibility for the tuition if accepted. ($800 until July 31 & $850 after that)