Application Fee:
Personal Information
First Name:
Preferred Name:
Last Name:
What is your preferred pronoun?
he/him/his
she/her/hers
they/them
other
Company Information
Company:
Title:
Category
Architecture - Engineering
Art - Entertainment
Banking - Insurance
Chamber of Commerce
Community Organization
Community Volunteer
Construction
Consulting
Defense
Education
Energy
Faith
Finance - Accounting
Food - Beverage
Foundations
Government
Health Care
Hotels - Travel
Investments
Law
Manufacturing
Media - Communication
Non-Profit
PR - Advertising
Real Estate - Development
Retired
Retail
Social Services
Transportation
Utilities
Other
If you've chosen "Other", list your Industry here:
What is your LinkedIn profile URL?
Direct Supervisor:
Title:
Email:
Work Phone:
Home Address and Contact Information
Address:
Address Line 2
City:
State:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
American Samoa
Federated States of Micronesia
Guam
Marshall Islands
Northern Mariana Islands
Palau
Puerto Rico
U.S. Minor Outlying Islands
Virgin Islands
Armed Forces Americas
Armed Forces Europe, the Middle East, an
Armed Forces Pacific
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Nova Scotia
Northwest Territories
Nunavut Territory
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon Territory
Zip Code:
-
Zip Suffix
Preferred Mailing Address:
Work Address
Home Address
Email:
Email 2:
Preferred Contact Method:
Work Email
Personal Email
Phone:
Phone 2:
Preferred Phone Number:
Work
Personal
How many years have you resided in Fort Worth or surrounding areas
0-5
5-10
10+
Which Fort Worth city council district do you reside? Go to https://myreps.datamade.us/
Which Fort Worth Fort Worth city council district are you employed in? Go to https://myreps.datamade.us/
What County Commissioner district do you live in? Go to https://myreps.datamade.us/
Demographic Information
Date of Birth
Gender
Ethnicity
American Indian/Alaskian Native
Asian
Black/African-American
Hispanic
Multiracial
Native Hawaiian/Pacific Islander
White
Other
Spouse/Partner Name
Application Information
To which class are you applying?
LeadershipClass 2023
LeadingEdge 2023
Have you previously applied to Leadership Fort Worth?
Yes
No
Describe your position and responsibilities at your current employer.
List key community, civic, religious boards, task forces or commissions in which you have been an active participant and give the approximate number of hours you volunteer with each organization per month. (If you moved to Fort Worth recently, please list activities you were involved with in your previous community.)
How do you define leadership? For example who influences you as a leader?
What do you consider to be the two most significant challenges facing Fort Worth today? Choose one challenge and discuss how you hope your Leadership Fort Worth experience will contribute to its solution.
How do you see yourself involved as a community leader in the future? What do you hope to gain from participation in Leadership Fort Worth that will help you achieve your vision?
Working across community is important to LFW, can you describe how you collaborate across different communities to build a more inclusive Fort Worth?
Tuition Waiver
Are you requesting a tuition waiver?
Yes
No
Tuition Waiver Amount Request:
Tuition wavier amount requested: $
Should you be selected, we need to know if you have any dietary restrictions as meals are served during program days. Please be as specific as possible or type NONE if you have no restrictions.
Other Accommodations
Please indicate if you require any additonal mobility, ability or learning accommodations for the duration of the program
Commitment
I agree to the above expectations. I have reviewed the program calendar and agree to the attendance requirements. Additionally, I hereby give Leadership Fort Worth the right to make inquiries regarding the information provided on this application.
How did you hear about Leadership Programs?
Check all that apply:
References
Reference #1 Name
Reference #1 Company & Title
Reference #1 Email
Reference #1 Phone
Account Creation