Apply to the Leadership Stark County Signature program

This is the first part of the application process. Please fill out the following form with your personal information. When you've completed this section, you will receive an email verifying you've been registered in our system. You'll be able to immediately proceed with the rest of the application, or you can come back and complete the application at a more convenient time. When you click 'save' your application is entered into our system. You may continue to make changes up until April 30, after which time we will close the process.

  • Be sure to continue on to the second page and answer the detailed background and essay questions.
  • Be sure to download, complete, and return Parts II and III.

If you have already begun the application process
please LOG-IN HERE to access your application.

Personal Contact Information

Full First Name
include middle name, if desired
Last Name
Preferred Name
Home Address
Home City
Home Zip Code
Home Phone
format: 555-555-5555

Work Contact Information

Employer
Position Title
Business Address
Business City
Business Zip Code
Business Phone
format: 555-555-5555

Other Information

Length of Residence in Stark County year(s)
Date of Birth / / 19
format: mm/dd/yyyy
Gender
Which of the following ethnicities do you identify with most strongly?
Preferred Mailing Address
Fax Number
format: 555-555-5555
Email
Password
Re-Enter Password

Group Interview Dates

You will be required to attend a group interview in order for your application to be considered. The sessions run from 5:15 - 7:15 p.m. Please indicate your preferred dates below.

Thursday, May 27
Wednesday, June 2