2010-2011 Adult Leadership Application
 (deadline for '10/'11 is June 5, 2010)
 

Criteria For Candidate Selection Includes:

  • Leadership Skills

  • Willingness and Ability to Assume Greater Community Responsibility

  • Diverse Background and Experience

  • Community Involvement
     

    • Download and print a PDF of this application   
     
    PERSONAL DATA  
    Name
    Title
    Name of Employer
    My company IS a current member of The Chamber of Commerce of St. Joseph County.
    My company IS NOT a current member of The Chamber of Commerce of St. Joseph County.
    Business Address Line 1
    Business Address Line 2
    City
    State
    Zip
    Business Phone
    Business Fax
    E-mail
    Home Address Line 1
    Home Address Line 2
    City
    State
    Zip
    Home Phone
    Home Fax
    Home E-mail
    Number of years in the
    Michiana community
    EDUCATION & SPECIALIZED TRAINING
    High School
    University(s)
    Degree(s)
    Specialized Training
    (Institutes, Seminars, Trade Schools)
    EMPLOYMENT HISTORY (Beginning with the most current position)
    CURRENT COMMUNITY INVOLVEMENT
    Provide name of organization and position held for volunteer, civic and community activities.
    MISCELLANEOUS QUESTIONS
    What has been your most satisfying community activity? Why?
    In your opinion, what is this community's most significant asset or challenge and how would you choose to influence it?
    What community leadership role would you like to fulfill five years from now?
    How did you learn about the Leadership Program and why are you interested in participating?
    Leadership South Bend/Mishawaka strives to select a class that is representative of our community. To help us achieve this goal, please explain how you can help contribute to the diversity of the class.
    Sponsoring Person
    Sponsoring Organization
     

    I understand that completion of this form does not guarantee placement in the 2010-2011 Leadership Program. The deadline for applications is June 5, 2010. 2010/2011 tuition is $1,700, or $1,600 if payment and application are received before June 5. Applicants will be notified of selection no later than June 30, 2010.

     
     

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    The Chamber of Commerce of St. Joseph Countyy
    401 E. Colfax Ave., Suite 310
    South Bend, IN 46617
    574.234.0051
    FAX 574.289.0358
    info@sjchamber.org
     
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