First Name
Last Name
M.I.
Nickname
Home Street Address
City
Zip Code
Email
Cell Phone
Age
How many years have you lived / worked in South Georgia?
How / from whom did you hear about South GeorgiaLEADS?
Name of Employer (if self-employed, please provide information related to your personal business)
Supervisor's Name
Business Street Address
City
Zip Code
Email
Business Phone
Current Title / Position
Number of years in current position
Major Job Responsibilities
Business / Professional Affiliations (if any)
What do you consider to be your highest professional achievement so far?
High School | Name & Location of School
Dates Attended
School #2 | Name & Location of School
Dates Attended
Degree
Major
School #3 | Name & Location of School
Dates Attended
Degree
Major
School #4 | Name & Location of School
Dates Attended
Degree
Major
Other Specialized Trainings / Certifications
Please list in previous leadership development programs you may have participated in, which year(s), and any key takeaways from that experience or leadership competencies gained. These can be community-based or professional leadership programs. If you have completed a leadership assessment or profile, please name which tool you utilized; i.e., Emergenetics, DISC, Five Voices, Clifton Strengths, others, etc.
Please explain in detail three civic, business, religious, political, or social activities that you have participated in over the last five years. Please indicate the name of the organization, your assignment or role, and briefly describe your responsibilities.
How much time do you commit each month to community, civic, professional. and/or other organizations and activities? If selected, will you be able to continue this level of commitment to existing community activities, and also actively engage in the Regional Leadership Initiative?
Please describe three accomplishments that you are most proud of in your work or volunteer efforts that have affected positive community change.
Provide what you see as your leadership strengths and provide example(s) of how you have demonstrated each.
Describe your personal commitment to engagement in South Georgia as a region today.
The concept of “regionalism” serves as the primary foundation of South GeorgiaLEADS and our leadership programs. Based on the concept that communities, and South Georgia specifically, work best when communities, counties and organizations work together across traditional county lines to promote issues, challenges and share solutions. What does the concept of regionalism mean to you and why is it important here in South Georgia?
If selected, how would you go about advocating for a regional approach in your home community? How do you think you can contribute to RLI and the greater mission of South GeorgiaLEADS?
Have you ever participated or served on a project or program at the regional level-this can be a community and civic engagement experience or in a professional setting? If yes, please describe that experience and your role in that effort. What did you accomplish and what was the greatest challenge you experienced working regionally? If no, please describe a current project or organization that you could apply a regional approach to support or that would benefit from a regional perspective or scope.
What are the three most pressing issues facing South Georgia as a region today and why do you think they are important to the future success and vitality of the region? What is your role, if any, in addressing these issues?
What are the skills needed by leaders in the region need to address these issues?
What skills do you think are needed by leaders to be able to implement regional concepts and/ or programs?
If you are selected to participate in the Regional Leadership Initiative (RLI), what do you hope to gain from the program? How will it benefit you personally and/or professionally?
Please provide at least two professional references and include Letters of Support indicating their recommendation and endorsement of your candidacy as a participant in South GeorgiaLEADS’ Regional Leadership Initiative. Letters may be submitted to apply@sgleads.org. Letters MUST be received no later than Friday, June 26. 2026 at 5:00pm.
Reference #1 | Name
Organization
Email
Phone
Reference #2 | Name
Organization
Email
Phone
Submit
