Confidential Application for Leadership Springdale

Instructions

Please complete each section fully. Applicants must be a member in good standing at the Springdale Chamber of Commerce. Application must be digitally signed by both the applicant and employer/sponsor (if applicable) and returned by August 1, 2025.

Selection Criteria

Participation in LEADERSHIP SPRINGDALE is open to persons twenty-five years of age or older who live and/or work in the Springdale area. Because the number of appointments to LEADERSHIP SPRINGDALE is limited, applicants who are not selected are encouraged to re-apply in subsequent years.

Participants will be chosen by the LEADERSHIP SPRINGDALE Selection Committee based upon the information submitted in this application. The Committee will be seeking leaders and potential leaders from a cross-section of the community and will select individuals who are active in either business, education, the arts, religion, government, community-based organizations or multi-cultural groups. In reviewing the applications, the Selection Committee will look for potential participants who demonstrate the following criteria:

Commitment and motivation to serve the Springdale area;
Policy shaping responsibility or position of leadership in employment and/or volunteer organizations resulting in the potential to have significant influence on important issues facing the community; and
Ability to make the time and resource commitment required by the program.

Applicants must have the full support of the people around them (business, organization, family, etc.).
Individuals may nominate themselves.

Participants are required to attend 5 optional meetings outside of the regular leadership class day. Those meetings range from City Council Meetings, School Board Meetings, Chamber Board Meetings and City Committee Meetings. An approved list of meetings will be given out on the first day of class and should be completed by the end of the 9 month program. Those who fail to meet these requirements will be withdrawn from the program with no refund of tuition.

Tip: Submissions work best without emojis or special characters. Thank you!

Name (First, middle, last) *

Name or Preferred Name (for nametag) *

Age: *

Date of Birth *

Male or Female: *

Shirt Size: *

Place of Birth: *

Home Address: *

Business Address: (please include City, State, Zip Code) *

Email *

Cell Phone: *

Business Phone: *

Length of Residence in Springdale Area: *

If married, Spouse's Name:

Number of Children, if any:

Any special needs/allergies:

Hobbies: *

Have you ever been convicted of, or entered a plea of guilty, no contest, or had a withheld judgment to a felony? *

If yes, please explain:

EDUCATION: *

order: high school, college, advanced degrees and/or specialized training. Include name and location of school, dates (from-to), and degree/major.

Special Awards for Academic Performance *

type "N/A" if none

Extracurricular Activities (include leadership positions held, special honors and awards received) *

type "N/A" if none

Present Employer: *

Service Date: *

Direct Supervisor Name *

Type of Organization: *

Title or Responsibility: *

Since: *

Briefly describe the responsibilities of your employment: *

List previous employment in reverse chronological order. (include active military duty) *

Employer, Title/Responsiblity, From-To, Reason for Leaving

What do you consider your highest career achievement to date? *

Business/Professional Affiliations (do not include civic organizations, public office or political activites) *

Name of Group, Position held or assignments, period of affiliation

If accepted into the LEADERSHIP SPRINGDALE program, you or your employer/sponsor will be billed $1,695.00 for the tuition fee which covers all program costs. Application and tuition will be due by August 1st, 2025. Select below who will pay tuition fee. *

If you marked needing financial assistance, and if you are selected, a representative of LEADERSHIP SPRINGDALE will contact you to make arrangements. Partial scholarship funds are limited. Therefore, you are encouraged to seek a sponsor if your employer is not paying the tuition.

I understand the purpose of the LEADERSHIP SPRINGDALE program, and if I am selected, I will devote the time and resources necessary to complete the program. Furthermore, even though emergencies do arise, I understand if I miss more than one session, for whatever reason, I will be asked to withdraw from the program and no portion of the tuition will be refunded. I understand the above commitments and agree to be bound by them in signing this application. *

Applicant's Digital Signature here:

Date

EMPLOYER COMMITMENT (if applicable): This applicant has the approval of this organization to participate in the LEADERSHIP SPRINGDALE program and has our full support which includes the time required to participate in the program. I understand that this commitment involves the participant’s mandatory attendance at monthly meetings during the next ten months.

Organization:

Employer's Digital Signature

Date

Comment