Community Leadership School Application 2024

Name *

E-mail *

Cell Phone *

Business/Organization Name *

Job Title *

Organization Mailing Address

Address Line 1 *

Address Line 2

City *

Zip/Postal Code *

Main Office Phone *

Supervisor's Name *

Supervisor's E-mail or Phone *

Billing Contact Name & Email Address *

Are you currently Volunteering with a Local Agency? *

Yes No

Please select "Yes" or "No." If "Yes," continue to Organization & Volunteer Responsibilities 1 & 2.

1. Organization & Volunteer Responsibilities

If applicable, list up to two community organizations in which you demonstrate an active leadership role beyond your professional affiliations and activities.

2. Organization & Volunteer Responsibilities

If applicable, list up to two community organizations in which you demonstrate an active leadership role beyond your professional affiliations and activities.

What areas would you like Mentorship in?

Career Planning and Development Managing Teams/People Conflict Resolution Networking/Consulting Skills Understanding Organizational Structure Project Management Media/Community Engagement Strategic Planning

What are the most important values you demonstrate as a leader? *

What are your expectations of the class? *

Is your organization aware you are applying for this program and are they willing to support your participation?

Yes No

Terms & Conditions

1. Applicants must have full cooperation and sponsorship from their employers and associations. 2. Applicants must possess the following: a) A demonstrated ability to achieve personal goals, b) A ready availability to achieve of time and resources to devote to community service, c) A personal commitment to the Greater Peoria area. 3. Participants are expected to: a) Attend all CLS weekly classes, b) Attend the orientation reception and graduation dinner, C) Participate in class projects, d) Attend as many field trips as possible. 4. Tuition: $1200 for Chamber Members or $1500 for Non-Chamber Members *(Please do not send payment with application - Payment options and instructions will be shared with selected applicants.)

Please review and check the box of each section to agree.

Applicant Full Name *

Type your full name in the box above to confirm that you have reviewed and understand the mission, program requirements, selection process, and participants' commitment to the Peoria Area Chamber of Commerce Community Leadership School. If selected, I will devote the required time and pay my full tuition before the program orientation session. If I am unable to comply with the requirements, I will voluntarily withdraw from the program. I understand that in the best interest of the class experiences for all participants, and participants may be removed from the class if, in the opinion of the Community Leadership School Steering Committee, a participant's conduct is not conducive to the work of the group. I further understand that tuition is non-refundable.

Date of Application Submission *

Format: M/d/yyyy

Select Date of Application Completion

Community Leadership School Application 2024

Peoria Area Chamber of Commerce

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