Leadership McKinley 2019 Application Form
Applications are due by December 28th, 2018
Your First and Last Name *
Your answer
Your Title *
Your answer
Company Name *
Your answer
Company Address *
Your answer
Home Address *
Your answer
Email (preferred for communication) *
Your answer
Phone (Work) *
Your answer
Phone (Cell) *
Your answer
Tell us a little about your position/responsibilities
Your answer
Thank you for your interest in the McKinley Leadership 2019 Program. This program is for professionals and community members in McKinley County. You do not have to be a member of the Chamber of Commerce to participate in the program. Selection for the program is based on interest, ability to attend all meetings (you cannot miss more than 1 class to be considered for the program) and interest in growing as a leader in our community. Classes are full day starting at approximately 9:00am and ending at 4:00pm. *
Tuition for the program: Chamber members $1250 and Non Chamber member $1450. Tuition is due on or before the first classroom date: January 30th. You may pay with check or credit card. You will receive an invoice upon being accepted into the program. Tuition can be paid by the individual, employer, or sponsoring organization. *
Do you have the full support of your employer for the time required to participate in the program?
In a few short sentences, tell us why you are interested in participating in this program: *
Your answer
What do you like best about the McKinley County community? *
Your answer
What are THREE challenges you see in our community that are important to you?
Your answer
What are THREE things you bring to this leadership program that will benefit our community? *
Your answer
What are THREE leadership competencies you hope to enhance through your participation in Leadership McKinley?
Your answer
Are you committed to attend every meeting? The program meets: January 17th Kickoff Reception, January 31st, February 28th, March 28th, April 25th, May 30th, June 27th, July 25th, August 29th, September 26th, October 17th. *
If you cannot attend a meeting, which meeting(s) can you not attend?
Is there any other information you would like to consider in your application, please share below:
Your answer
Your commitment: I understand the purpose, requirements and attendance expectations for this program. I understand that completion of this form does not guarantee my acceptance as a participant. If selected to participate, I will make the commitment to attend the classroom days. *
Thank you for your submitted application
You will be contacted by January 5th, 2019 by a member of the chamber staff.
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