Fundamental Medicare, LLC

2026 Tipp City Chamber Teen Leadership Academy application

This program is for any student who resides in the Tipp City or Bethel School Districts in Ohio. Students must be a Junior entering their Senior year of High School (graduation in 2027)

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Email*

First & Last Name*

Nickname preferred

Cell phone number*

Home phone number

Street Address*

City, State, Zip Code*

Current employer (if currently employed)

Date current employment began

Current job duties

Education*

List name of high schools and dates attended along with any post-secondary.

Honors/Awards

Please list any high school honors or awards you have received or accomplishments you have achieved.

Organizations

Please list community, civic, religious, social, athletic and other organizations in which you have been involved in during high school.

How has your involvement in these activities helped to develop your leadership skills?

Option 1

How would you describe your knowledge of community structure and policies?

Poor

Fair

Good

Excellent

In your opinion, what are the three (3) most pressing issues facing Tipp City (45371) today?*

Please give your reasons why and any recommendations for approaching and resolving these issues. (250 word limit)

What are the attributes of a leader?*

Name a leader and why you admire them. What does it take to be a great leader? (250 word limit)

What does community involvement mean to you?*

Please upload two (2) recommendation letters.

Drop files here or

Max. file size: 10 MB.

Letters must come from community leaders, faculty members, club advisers, etc. Only one (1) of the letters may be from a school academic faculty. Letters may not be from a parent, guardian, or relatives. Files need to be named clearly with your name. (for example: Joe_Smith_1rec.doc, Joe_Smith_2rec.pdf) *Recommendation letters can be emailed (samantha.mcfadden@tippcitychamber.org) or hand delivered / snail mailed to the Chamber office (12 South 3rd Street, Tipp City).

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	(Date: 6/21/2026)

Tipp City Chamber of Commerce

Fundamental Medicare, LLC

Fundamental Medicare, LLC