2026 Leadership Pinebelt Application

Name of Applicant(Required)

First Last

PURPOSE: To develop and cultivate annually emerging community leaders who dedicate themselves to the betterment of the Hattiesburg Metropolitan Statistical Area (MSA) and its citizens.

INSTRUCTIONS

Fully complete each section. If you need to stop and come back to the application at a later time, there is an option at the bottom of the pages to save your answers.
Application MUST be TYPED and SIGNED BY APPLICANT AND EMPLOYER (if applicable).
Application MUST contain a recent photograph suitable to use in publications and for publicity.
No extra pages or letters of recommendation are allowed.
If selected, tuition is: $1,000 for ADP Members / $1,200 for Non-Members (payment or proof of payment in process is due by FEBRUARY 27, 2026 and is NON-REFUNDABLE).

SELECTION CRITERIA

PARTICIPANTS WILL BE CHOSEN BY THE LEADERSHIP PINEBELT STEERING COMMITTEE BASED UPON THE INFORMATION PROVIDED IN THIS APPLICATION.

These leaders and potential leaders will be representative of all aspects of the area and will reflect the diversity of the community. Age limit: Not over age 45 by date of selection.

Participation in the LEADERSHIP PINEBELT program is open to emerging community leaders living and/or working in the Hattiesburg MSA (Forrest, Perry, Lamar, Covington counties). Only 20 individuals will be selected to participate in the program.

Since the number of participants is limited, nominees who are not selected are encouraged to reapply in subsequent years. Applicants must have the full support of the organization or corporation they represent.

Attendance at the monthly sessions is mandatory, as well as small group meetings.

This field is hidden when viewing the form

FOR OFFICE USE ONLY

This field is hidden when viewing the form

Number of Times Applied

This field is hidden when viewing the form

Date Application Received

This field is hidden when viewing the form

Nominated by:

Personal Information

Please complete all information.

Name(Required)

First Middle Last

Nickname Preferred

Birth Date(Required)

T-Shirt Size(Required)

Please select one.

Age(Required)

Gender(Required)

Male

Female

Place of Birth(Required)

Home Address(Required)

Street Address Address Line 2 City State ZIP Code

Business Address(Required)

Street Address Address Line 2 City State ZIP Code

Cell Phone(Required)

Business Phone

Email(Required)

Enter Email Confirm Email

Length of residence in Hattiesburg Area(Required)

(Years / Months)

Spouse Name (if applicable)

First Last

Children (names & ages) (if applicable)

Name

Age

Hobbies(Required)

Please attach a photo(Required)

Color photo, photo must be suitable for publication, size to if possible, if unable to attach, submit to v.henson@theadp.com with the subject as 2026 Leadership Pinebelt – Photo Submission – Your Name

Accepted file types: jpg, png, Max. file size: 50 MB.

Education

List(Required)

Name & Location of School

Dates (from-to)

Major

Degree

Special Awards for Academic Performance(Required)

Extracurricular Activities(Required)

(Leadership positions held, special honors/awards received during school years)

Employment

Present Employer(Required)

Service Date(Required)

Type of Organization(Required)

Title or Responsibility(Required)

Since(Required)

Briefly describe your responsibilities:(Required)

List previous employment beginning with the most recent (include active military duty)(Required)

Employer

Title / Responsibility

From

To

What do you consider your most satisfying career achievement to date?(Required)

Business / Professional Affiliations (not including civic organization, public office, or political activities)(Required)

Community Involvement

Include most recent community, civic, religious, political, government, social, athletic, or other activities. Ifyou are new to the community, list involvement in previous location. Do not include business/professionalactivities.

Organization

Assignment / Position

Describe Responsibilities (briefly)

What do you consider to be your most important accomplishments in one of the above organizations? Why?(Required)

If you had one week to devote to a community service, what would you do and why?(Required)

If you have not had the time or interest to become actively involved, what conditions have changed that now enable you to seek involvement in the community?(Required)

General Information

INFORMATION(One of the goals of LEADERSHIP PINEBELT is to build a network of community leaders who can enhance their problem-solving and other leadership abilities through shared perspectives and working together.)

Why are you applying to Leadership Pinebelt?(Required)

Discuss one specific problem you’ve observed in Great Hattiesburg. Tell why it’s important, the issues it raises, and make at least one suggestion for its solution.(Required)

Why should you be chosen for Leadership Pinebelt?(Required)

Tuition

TUITION

A tuition fee for this program is set annually by the Steering Committee. The fee covers all expenses (food, program materials/tee-shirt, and lodging) for all meetings during the program; transportation is limited.

Employers and/or sponsors of participants are encouraged to pay this tuition; however, participants may share in this cost as well as out-of-pocket expenses for team projects.

Tuition is required for each individual but is not intended to prevent or limit participation.

Tuition payment (or proof of payment in process) must be received by February 27, 2026. Tuition is NON-REFUNDABLE.

Should tuition assistance be needed, arrangements must be made with the Leadership Pinebelt Program Director at the time the applicant is accepted into the program and will require alumni scholarship committee approval.

VII. COMMITMENT

(To graduate from the LEADERSHIP PINEBELT program, a participant is expected to attend all sessions.)

Orientation / ADP Overview – Thursday, March 5, 2026, 2:00–7:00 p.m. Required — no exceptions.
REACH Course – Friday & Saturday, March 13 & 14, 2026, 8:30 a.m.–3:00 p.m. Required — no exceptions.
Retreat – Wednesday & Thursday, April 15 – 16, 2026, out-of-town session. Required — no exceptions.
Accelerate – Friday, June 12, 2026, 11:30 a.m.–1:00 p.m. Required — no exceptions.
Graduation / Project Presentations – Tuesday, September 29, 2026, 5:30–7:00 p.m. Required — no exceptions.
Community Educational Seminars / Tours / Meetings – Approximately 10 local sessions conducted over the course of the program. Sessions are usually a morning or afternoon. To be considered present, you must attend ALL segments of a session.
Community Development Projects – All participants will work on a community development project during the program. Small group meetings will be called as necessary.

*Note: Emergency absences are handled on an individual basis.

Signature(Required)

I understand the purpose of the LEADERSHIP PINEBELT program, and if I am selected, I will devote the time and resources necessary to complete the program. I understand that emergencies arise; however, repeated absences from program meetings may result in my being dropped from the program and that no portion of the tuition shall be refunded. I understand the above commitments and agree to be bound by them in signing this application. To graduate from the LEADERSHIP PINEBELT program, attendance is mandatory.

Date(Required)

Supervisor Name(Required)

First Last

Supervisor Email(Required)

A signature form will be emailed to the supervisor. The signed digital form must be submitted by the application deadline. Please let your supervisor know to expect this email and to check their junk folder if they haven’t received it.

Enter Email Confirm Email

APPLICATIONS MUST BE RECEIVED BY THE DEADLINE (January 30, 2026, 5:00 p.m.) For questions or comments, please email v.henson@theadp.com.