Vision Program Application

Company Info

More About You

Emergency Contact Information

Employer Information

Please list previous positions held with your present employer and/or other employers, in reverse chronological order:

Community & Professional Involvement

Please list civic, professional, business, religious, social, athletic, or other organizations in which you are currently or having previously been a member of:

Personal History

Professional References

Please list two individuals knowledgeable with respect to your leadership capabilities and your past performance.

First Reference:

Second Reference:

Commitment

To graduate from the Vision St. Charles County Leadership Program, a participant is required to attend all sessions. Attendance for both overnight retreats is mandatory. A majority of the sessions are on the third Thursday of each month; however, those are subject to change based on holidays or other events.

A class member is allowed one absence throughout the program year. An absence of more than one hour from a program day counts as an absence.

Applicant Commitment & Release of Liability

If selected as a participant in the Vision St. Charles County Leadership Program, I am willing to attend all the functions sponsored by the program, and I understand that attendance is mandatory. I understand that if I fail to meet any of the obligations of the program, I may be asked to withdraw or may not graduate with my class. I also accept liability for myself throughout the program.

I hereby release Vision St. Charles County Leadership, its officers and directors, of all liabilities for injuries and damages sustained by me in connection with the Vision St. Charles Leadership Program.

Thank you for your application to:

Vision St. Charles Leadership Program