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 will not be considered complete until all requested information, including a headshot being submitted. Please note that each class is limited to 20 participants, and submission of an application does not guarantee acceptance into the program.

If more than 20 applications are received, a selection panel will review submissions to ensure the class represents a diverse cross-section of industries, backgrounds, and communities throughout Bastrop County.

All questions included in this application are intended solely to support diversity and representation within the program and are not meant to limit participation.

Please make all checks payable to the Bastrop Regional Chamber of Commerce.

Checks may be mailed to:
Bastrop Regional Chamber of Commerce
927 Main Street
Bastrop, TX 78602

How will your tuition be handled?

My organization is prepared to cover tuition if I am accepted. ($850 until July 31 & $900 after that)

I will assume responsibility for the tuition if accepted. ($850 until July 31 & $900 after that)

Session 1 attendance acknowledgement *

By checking the box below, you are acknowledging that attendance at Session 1 is REQUIRED, and if missed, no refund will be issued. 

More than one absence from the eight sessions, will result in your ineligibility to graduate with this year’s class.

I acknowledge my attendance at Session 1 is REQUIRED