First Name *

Last Name *

Email *

Cell Phone *

Business Name *

Business Address *

City *

State *

Enter required value

Postal Code *

Work Phone *

Employer/Supervisor Contact *

Title *

Employer Phone *

Employer Email *

Please list any special accommodations needed (dietary or otherwise): *

Please provide a short bio (3-5 sentences) to be included in our participant materials &website. *

Participant: Why do you want to participate in the Leadership Fort Dodge program? *

Acknowledgement of Program Dates: *

By checking this box, you acknowledge the dates of all sessions.

Sessions are held on the 2nd Thursday of each month, September through May, with the exception of the March session which is the 3rd Thursday. 

Sessions are 8:00am to 5:00pm. 

Dates for the 2025-2026 program include:

Wednesday, August 27, 2025 - Afternoon Orientation

Thursday, September 11, 2025 

Thursday, October 9, 2025

Thursday, November 13, 2025

Thursday, December 11, 2025

Thursday, January 8, 2026

Thursday, February 12, 2026

Thursday, March 19, 2026

Thursday, April 9, 2026

Thursday, May 14, 2026

Thursday, May 21, 2026 - Lunch Graduation

**Please note the attendance requirements (listed below) apply for each of these sessions.

Acknowledgement of Participant Requirements: *

By checking this box, you acknowledge the program expectations & requirements. 

• Each participant is expected to attend one Fort Dodge City Council meeting or Webster County Board of Supervisors meeting.
• Each participant must complete one volunteer/service activity outside of the session during the course of the program.

Attendance Requirements: *

• Each participant is allowed ONE absence during the duration of the program.
• Participants who have more than one absences will be given the opportunity to make up the absence with an additional service project.
• Any no call/no show may result in immediate removal from the program.
• ***If you know that you will not be able to meet this attendance requirement, please do not apply to participate.***

By signing and submitting this application, I acknowledge receipt of the above attendance policy and understand what is expected of me as it relates to Leadership Fort Dodge and attendance. I also agree to pay the fee of $500 and understand that refunds will not be issued to participants who fail to meet the expectations of the program or who leave the program following the August 27 orientation. 

Applications are not considered complete until both the the application & $500 fee are received. 

Participant Signature: *

Participant Printed First & Last Name: *

Date: (MM/DD/YYYY) *