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Leadership Bartlesville Class of XXXII Online Application

Home » Membership Benefits » Leadership Bartlesville Class of XXXII Online Application

Leadership Bartlesville Class XXXII Application

Areas marked with * are required.

"*" indicates required fields

Sponsoring Organization

Nominees for the Leadership Bartlesville program must have the support and commitment of their sponsoring business or organization. The signature of the sponsoring organization is necessary as an indication of support of the nominee’s participation in Leadership Bartlesville, and understanding of the attendance requirements and expense involved.
Representative Name*

Agreement

Agreement*
Electronic Signature of Applicant*
This serves as your signature for the application.
Date
MM slash DD slash YYYY

Confidential Application Class XXXII

Home Address
Work Address
MM slash DD slash YYYY
Do you anticipate being a resident in the Bartlesville area
Have you previously applied for a Leadership Bartlesville class?
Have you ever participated in any other Leadership class?
Preference will be given to those who live in the community and/or who are actively engaged in the community.

Education Background

Begin with high school, then college(s), business or trade schools and/or special training.
Schools
Name and City
Dates (from-to)
Degree/Major
 

Employment History

Account for all periods including military active duty
Employment
Employer
Employee's Responsibility/Title
Dates Employed
 

Community Service/Activities

Please list, in order of importance to you, other civic, religious, social, athletic or other such organization of which you are or have been a member.
Organization
Dates of Membership
Position(s) Held
 
Please list your professional and business associations and affiliations.
Organization
Dates of Membership
Position(s) Held
 

General Information

Commitment

To graduate from the Leadership Bartlesville program, the participant must be aware and commit to the following: The program consists of a two-day orientation retreat which is mandatory, and nine monthly class sessions. The program requires a definite commitment of time on the part of each participant as well as their employer. If a class member cannot attend a scheduled session, they must notify the Program Chair 48 hours prior to that session. Members with more than one and a half sessions of absence in the Leadership Bartlesville program will be dropped from the program without a tuition refund, unless the Leadership Bartlesville Steering Committee chairman has previously approved absences above the limit. Excused absence requests must be submitted in writing.

By giving your initials, you agree to the commitment above.
This field is for validation purposes and should be left unchanged.
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