Marinette Menominee Area Chamber of Commerce Community Leadership Academy

First Name *

Last Name *

Title/Position *

Name of Business *

Business Address

Address Line 1 *

Address Line 2

City *

Zip/Postal Code *

Business Phone Number *

Email Address *

Home Address

Address Line 1 *

Address Line 2

City *

Zip/Postal Code *

Home Phone/Cell Number *

Do you have full support of your employer for the time required to participate in the Community Leadership Academy? *

Yes No

Employer/Sponsor Contact Information: Please provide the name and contact information for an individual at your workplace with whom we can share information/updates on this year's Community Leadership Academy class.

Title

First Name *

Last Name *

Suffix

Email address *

Phone number *

How many years have you lived/worked in the Marinette, Menominee, and/or Peshtigo area? *

How much time each month do you commit to community, civic, professional and other organizations and activities? *

	1-5 hours	5-10 hours	10+ hours
Hours on your own time	1-5 hours	5-10 hours	10+ hours

Hours on employers time	1-5 hours	5-10 hours	10+ hours

Please note : the program usually requires 10-20 hours of participation outside of normal class time.

What are the reasons you think you would be a good candidate for the Community Leadership Academy? *

How do you think your expertise & experiences would contribute to the program? *

In your opinion, what is the most significant problem facing our region today, and what are you willing to personally contribute to help work toward solutions? *

What would you hope to gain by participating in the Community Leadership Academy? *

Do you understand that attendance at ALL class sessions is required and necessary to graduate? *

Yes No

Tuition and Funding: Tuition for the Academy is $700 for Marinette Menominee Area Chamber of Commerce members and $850 for non-members. It is payable at the time of acceptance into the program. Tuition payment should be made payable to Marinette Menominee Area Chamber of Commerce and mailed to : 601 Marinette Ave., Marinette, WI 54143.

Partial tuition scholarships will be available to a limited number of non-profit and small business applicants (1-5 employees). If you wish to apply for assistance, please request an amount and your reasons for the request.

Please attach a current resume that highlights the following qualifying categories and personal information: Employment History, Education, Special Recognitions, Leadership Achievements, Organizations & Activities you are involved in (past & present) and professional/personal references.

Resume Upload *

All Applications are subject to confidential evaluation, however, if you are chosen as a candidate for the program, your application will be shared with the Employer/Sponsor listed above. Since the program has limited number of participants, if you are not selected for the current program, you are encouraged to apply again next year.

Marinette Menominee Area Chamber of Commerce Community Leadership Academy

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