Encore Louisville Application

This application will be used to select participants for the Encore Louisville Class of 2022. Please review the Program Calendar before submitting your application.

In addition to completing this application, please send a headshot photo via email to Aimee Jewell.

You must complete the entire application in one session. Before beginning the application, we recommend you gather the information you need and compose the short answer responses in another word processor (you can copy and paste into the application).

The application deadline is Tuesday, November 30, 2021 at 11:59 p.m. If you encounter any problems submitting this form, please contact Peggy Clements at (502) 561-5228 or email.

Title (optional)
Name*
First Middle Last Suffix
Preferred Email*
Enter Email Confirm Email
Is the preferred email above your work or home email?*
Home Email*

Please re-enter your home email in this field even if you entered it above as your preferred email above.
If applicable, please list your work address (If not skip to home address)
Street Address City State ZIP Code
Preferred Phone*
Home Address*
Street Address City State ZIP Code
Mobile Phone*
(###) (###-####)
Demographics
Diversity is an important part of our mission. In an effort to understand our applicants and ensure all populations are served, we have a few questions we'd like to ask. Please know that:

- This information is used to collect demographic data on our applicants.
- The information will not be used for a discriminatory purpose.
- Only Leadership Louisville Center staff and the selection committee will have access to this information.
- Your responses will be kept private and secure.
Date of Birth*
Date Format: MM slash DD slash YYYY

mm/dd/yyyy
Gender*
Race/Ethnicity*
Are you a veteran of the U.S. armed forces?*
Do you identify as part of the LGBTQIA+ community?*
Are you foreign born?*
If foreign born, what is your country of origin?
If not from Louisville, enter hometown city and state (and country if not the U.S.)
Please provide a one paragraph biography describing your career, experiences, and skills. This will be shared with other encore Louisville participants in a class handbook and will be provided to nonprofits that you would be working with.*
Employment Status
Employment status*
- 1. Employed (Not retired)
- 2. Retired and now self-employed
- 3. Retired or retiring this year - not working post-retirement
Your Company and Job Title (for publication)
PLEASE READ: Please indicate your preferred title and company for publication on our website, in press releases, and in the graduate directory. The company name you provide will also be used on your nametag when you attend Leadership Louisville Center events. In the case of those retired and now self-employed, you might enter "President" for your job title, and "Jones Consulting" for your company. If you are retired and not employed, please put "Retired" for your job title, and for company, specify how you'd like to be represented, for example, "Retired Healthcare Executive", or LG&E and KU Energy, Retired." See examples of how our current class is represented here: Encore Louisville Class of 2021 Roster
Current Job Title (for publication, if applicable, or enter "Retired")
Current Company (for publication, if applicable, or enter "Retired")
Your Company and Job Title (pre-retirement)
If you entered “Retired” above, please indicate the title and company of your last role (or the role where you spent most of your career, whichever you prefer).
Job Title (pre-retirement)
Company (pre-retirement)
Industry (where you've spent most of your career)*
Commitment
Commitment to attendance at program days*

I understand that participation in the Encore Louisville program requires a commitment to attend each of the program days (5 total) in their entirety. Missing more than one program day (or equivalent hours) could result in dismissal from the program. Late arrivals and early departures will be tracked by the Leadership Louisville Center staff. Review the program day dates linked below and mark them on your calendar.
Program Calendar
Commitment to group work*

I understand that Encore Louisville involves group work, which will take place outside of the program days. It is expected that each class member will participate in one to three of the four project cycles, and active participation in the project is requested. The time commitment for each group project will be 10-15 hours of meetings and volunteer work over (approximately) a 90-day period. The Encore Louisville program will only be successful when all participants are committed to the project work.
IMPORTANT - PLEASE READ!
After clicking the Submit button, it may take a few moments to process your application. Once your application is submitted successfully, you will see a confirmation message and receive an email within five minutes that contains all the information you submitted. If you have any problem with this application, contact Peggy Clements at (502) 561-5228 (office) or (502) 338-0751 (cell).
CAPTCHA

Encore Louisville Application

Encore Louisville Application

Please re-enter your home email in this field even if you entered it above as your preferred email above.

Demographics

Employment Status

Your Company and Job Title (for publication)

Your Company and Job Title (pre-retirement)

Commitment

IMPORTANT - PLEASE READ!

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