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LEADERSHIP ANSON
DEVELOPING A COMMITMENT TO COMMUNITY THROUGH LEADERSHIP
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Sponsored By:
Anson County Chamber of Commerce
Hornwood Inc.
South Piedmont Community College
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Leadership Anson Application
Please type or print legibly//Attachments of additional information are acceptable
*PERSONAL DATA
Name____________________________________________________________________________________
Last First Middle Preferred
Date of Birth ____________________ Sex:_____________________ Race:________________
Home Address___________________________________________________________________________________
Street City State Zip Code
Home Phone Number: ___________________________ E-mail Address: ____________________________
*EMPLOYMENT
Employer: _________________________________________________ Full Time: _______ Part Time: _______
Business Mailing address:_____________________________________________________________________
Post Office Box # and/or Street City/State Zip Code
Work Phone #: _______________ Work Fax #: _______________ E-mail:__________________________
Position/Job title:_____________________________________________________________________
Responsibilities __________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
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*SCHOLARSHIP INFORMATION
Funding for scholarships is available on a limited basis, and is offered if an applicant is not being sponsored by their employer, church, club or organization. Scholarship applicants will be interviewed by a Leadership Anson Oversight Committee sub-committee.
Please check the appropriate box below if you would like to be considered for a scholarship.
___ Full Scholarship @ $350.00 ___ One-Half Scholarship @ $175.00
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*EDUCATION
Please include high school, colleges, advanced degrees and/or specialized training.
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Name and Location of School
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From-To
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Degree
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Major
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Please list special awards for academic performance.
_________________________________________ ________________________________________
_________________________________________ ________________________________________
Please list extracurricular activities (offices held, honors received, etc.)
_________________________________________ ________________________________________
_________________________________________ _________________________________________
*COMMUNITY INVOLVEMENT
Please list community involvement activities.
_________________________________________ ________________________________________
_________________________________________ ________________________________________
_________________________________________ ________________________________________
_________________________________________ ________________________________________
Please mark the categories which describe your areas of leadership activity and interest.
___ Social Services ___ Government ___ Business/Industry ___ Religion ___ Art
___ Medical/Health ___ History ___ Media ___ Law ___ Education ___ Other: __________
* FOR MORE INFORMATION
Leadership Anson is a complete learning program to develop community leaders from all walks of life. Sessions begin in January with a mandatory overnight retreat. Following the retreat, sessions will be held every other Tuesday beginning on the last Tuesday in January. The class sessions end in June with a graduation ceremony.
Send applicatons to: Leadership Anson, c/o Anson County Chamber of Commerce
P.O.Box 305, Wadesboro NC 28170-0305
For More Information, call 704-694-4181
or E-mail or go to ansoncounty.org
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