Leadership Council Application

To apply to the Harris County Leadership Council, please complete all questions.

Click here to learn more about HCLC.

Voter Information

First Name *

Last Name *

Date of Birth (mm-dd-yyyy) *

Mailing address

Street *

City *

State *

Zip *

Contact Information/Social Media

Preferred Email Address *

Primary Phone Number format: (xxx) xxx-xxxx

Twitter

Facebook

Employment Info

Employer

Job Title

Industry

Years Employed

Job Responsibilities

Education

School

Years Attended

Organizations and Activities (list all organizations, positions held and dates)

distinctions (list the honor and date awarded)

REFERENCES You are required to provide us with two references. References that will be accepted are: HCLC alumni, community leaders, elected officials (current or former) or Republican Party affiliates.

References

Reference First Name

Reference Last Name

Reference Company Name

Reference Job Title

Reference Phone Number

Reference Email

HCLC Graduation Year

References

Reference First Name

Reference Last Name

Reference Company Name

Reference Job Title

Reference Phone Number

Reference Email

HCLC Graduation Year

Essay

Essay #1 In 1000 Characters or less, please describe why you want to participate in the HCLC program, what you want to get out of the program, and how you would apply what you have learned from the program.

By clicking Submit, I affirm that the foregoing statements are in all things true and correct.

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