Leadership Kingsport Application

Thank you for your interest in the Leadership Kingsport program. Below is a digital form copy of the program application. Please read the following information before completing the form.

Thank you.

Program

Founded in 1983, Leadership Kingsport is a program of the Kingsport Chamber Foundation. Approximately 30 area residents are chosen each year to participate.

Leadership Kingsport’s mission is “to develop leaders who give life to community dreams.” Anyone interested in serving the community is encouraged to apply.

This program provides opportunities for leaders and emerging leaders from various sectors of the community to study local and regional issues, and to further develop their leadership skills.

Selection Criteria

Selection of Leadership Kingsport participants will be based on:

Interest in serving on boards, commissions, in volunteer roles and/or in public office.
Demonstrated commitment, motivation, and interest to serve the community.
Recognized leadership ability in community, civic, professional or other organizations.
Attaining a cross section of participants from business, government, community service, minorities, etc.

Class Schedule

Orientation – August
Mandatory Retreat – September
Program Days are normally the second Thursday of each month, October – May, 8am-5pm.
Mandatory Nashville trip – March

Full attendance and participation in the Leadership Kingsport program is expected.

Orientation, Retreat, Nashville trip, and Community Impact Projects Day are mandatory.

Attendance at all program days is expected (any absence must be approved and make-up work completed in order to be eligible for graduation)

Tuition

Non-refundable tuition covers retreat, food, lodging, training materials, monthly training sessions and administrative costs. Tuition is $2,000.

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Contact Information

Name *

Name of Preference

School *

Grade *

T-Shirt Size *

Birth Date *

Sex *

Cell Phone *

Home Phone

Facebook Username

Twitter Username

Home Address *

City *

State *

Zip Code *

Email Address *

Parent or Guardian's Name *

Emergency Contact Information

Transportation is the responsibility of the applicant. Will you be driving yourself to the sessions? *

If not, explain travel arrangements.

Why do you want to participate in the S.H.O.U.T.!® Program? *

List 3 community, church or school activities you take part in. Explain your involvement and why you enjoy the activity. Feel free to list any awards or recognition you have received due to involvement. Attach additional sheet, if necessary. *

List any part-time job experience, paid or volunteer, and briefly explain what it / was involved *

Do you currently have a part-time job? *

Hours Perk Week (If applicable)

Do you participate in school sports? *

Would extracurricular activities interfere with your attendance at the S.H.O.U.T.!® Program? *

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Reference

Name

Position

School/Firm/Organization

Address

Phone Number

For how long and in what capacity have you known the applicant? *

What do you consider to be the applicant’s primary talents or strengths? (Please give an example.) *

What do you consider the applicant’s chief weaknesses? *

Comment on the applicant’s relationship with his or her peers. *

Other comments you would like to share about the applicant.

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Kingsport Leadership Programs

Kingsport Chamber

Contact Us!

[email protected]
(423) 392-8800

Mail Us!

400 Clinchfield Street Suite 100
Kingsport, TN 37660