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CONFIDENTIAL APPLICATION - DUE FRIDAY, JULY 26, 2024
*First and Last Name:
First and Last Name
*Cell Number:
Cell Number
*Personal Address:
Personal Address
*Personal Email Address:
Personal Email Address
*Emergency Contact (Name and Phone Number)
Emergency Contact (Name and Phone Number)
*Employer/Organization:
Employer/Organization
*Job Title:
Job Title
*Work Email Address:
Work Email Address:
*Work Address:
Work Address
*Sponsored By: (Organization Name)
Sponsored By
*Select Sponsor Type:
Sponsor Type
Employer
Organization/Business
Self
Other
*Sponsor Name:
Sponsor Name
*Sponsor Phone Number:
Sponsor Phone Number
*Sponsor Email:
Sponsor Email
*How many years have you lived in Pitt County?
How many years have you lived in Pitt County?
*Please list three civic, professional, business, religious, social, athletic, and other organizations of which you are or have been a member in the last three years? (Please separate your answers with a comma)
Member Organizations
*Please include any achievements you have received in the last three years. (Please separate your answers with a comma)
Achievements
*What does Leadership mean to you?
What does Leadership mean to you?
*What are 2-3 goals you'd like to get out of participating in Leadership Institute? (Please separate your answers with a comma)
Goals of LI
*What do you view as your strengths and in what areas do you believe you could improve?
Strengths & Improvements
*What do you feel are the most significant challenges facing Greenville-Pitt County?
Challenges of Greenville-Pitt
No more than two (2) days can be missed in order to graduate. Arriving late or leaving early will be counted as a half-day’s absence. If a participant is unable to attend a session, he/she is expected to notify the Chamber’s staff coordinator at least 24-hours in advance of the scheduled session. Failure to adhere to the enforced policy will result in a participant not being able to graduate from the program.
*Submission of this application confirms you and your employer have read and understand the attendance policy as stated here and, in submitting this application, agree to be bound by such.
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