2026-2027 Leadership Rockingham Application
 This application must be completed and returned by Friday July 24th, 2026 either electronically or by mail to:
 *if you mail this application please DO NOT send payment with the application.
Leadership Rockingham
c/o Diane Sawyer
PO BOX 1020
Reidsville, NC 27323
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Name ( First, Middle, Last Preferred) *
Home Address *
Home/Cell number *
Years in Rockingham County *
Date of Birth *
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DD
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YYYY
Gender *
Business Name *
Business address *
Business Phone  *
Comany Position/Title *
Length of time there *
High School, College, Trade School names and Year Graduated  *
Special Honors/ Awards/Recognition  *
Current and Past community involvement  *
How much time do you typically commit to community, civic, professional and other organizations?  *
Describe a professional and non-professional situation where you took the lead to accomplish a task. 
 *
Name a characteristic that you believe every leader should possess *
Provide an example of failed leadership *
Select a person who has had a tremendous impact on you as a leader. Why and how did this person impact your life?  *
Are you a registered and active voter?  If not, explain why. *
What are your chief hobbies and recreational interests?  *
Why do you want to be in this program? *
Do you ave any dietary restrictions? *
REFERENCES
Please list two (2) people who are knowledgeable about your leadership performance/potential. ( Include Name, relationship, email and cell phone number) *
PROGRAM REQUIREMENTS

Participation in the Leadership Rockingham program requires significant time and commitment.

 Required sessions and activities include:
 
-Opening Retreat September 9, 2026
-Monthly Sessions — 2nd Wednesday of the month October through April 8:30 to 4:30
-Rockingham County Exploration Days
-Graduation Ceremony— May 12th, 2027

Your successful completion of the program is contingent upon your full attendance and involvement in all of the above activities. 

If your schedule will not permit your complete participation, please delay your
application until you can make a full commitment of time to this program. 

I understand the purpose of the Leadership Rockingham program. If I am selected as a participant, I will pay my tuition by August 31st, 2026 and will devote the time as described to Leadership Rockingham. 

Applicant Signature and Email. By typing my name below I intend for this to act as my electronic signature.  
 *
TUITION
 
Tuition for participants is $595. This amount covers all expenses including meals, program materials and
retreats. 

Applicants will be notified by mail of their acceptance by August 3rd, 2026 and tuition is due by
August 31st, 2026. (Payment details below)

Using the space below tell us; Who will pay your tuition?
Financial assistance may be available. Please contact Diane Sawyer president@reidsvillechamber.org


This application must be completed and returned by Friday July 24th, 2026 either electronically or by mail to:
 
Leadership Rockingham
c/o Diane Sawyer
PO BOX 1020
Reidsville, NC 27323


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