Leadership Denison Institute Application Class of 2023

Name

Title

First Name *

Last Name *

Suffix

Address

Address Line 1 *

Address Line 2

City *

Zip/Postal Code *

Email Address *

Cell Phone *

Are you or your business a member of the Denison Area Chamber of Commerce? *

Yes No

Will your employer be responsible for your enrollment and paying the tuition? *

Yes No

Employer, if applicable

Employer Address

Address Line 1

Address Line 2

City

Zip/Postal Code

Position Title at Employer

Primary Responsibilities

Work Phone *

What is your current community involvement (Civic Clubs, Organizations, Volunteer work)? *

Prior community engagement is not a requirement of the program but a willingness to commit to future engagement is a must.

What specific skills/knowledge do you hope to gain from your participation in Leadership Denison? *

Please be specific in your reasons for participating in Leadership Denison.

What do you think is the most significant challenge facing Denison? *

Be it schools, streets, business, civic - we want to know what you think so we can better tailor our program.

How did you hear about Leadership Denison? *

How would you like to "give back" to the Denison Community, as a Leadership Denison Alum? *

What are you goals after completing the program?

Professional References recommending you for Leadership Denison

Title

First Name *

Last Name *

Suffix

Reference Phone

Reference Relationship

Professional References recommending you for Leadership Denison

Title

First Name *

Last Name *

Suffix

Reference Phone

Reference Relationship

Headshot *

You must upload your chosen headshot for the application to be submitted.

Resume *

Leadership Denison requires your employment resume for submission.

I understand that Leadership Denison is a learning experience and requires attendance at monthly meetings, which are FULL DAY 8AM - 5PM sessions, over a period spanning September - April with Graduation occuring at the May Quarterly Luncheon. *

Yes I understand

I understand attendance at the Meet & Greet in late August, Full Day Retreat in September and Graduation are MANDATORY. I further understand one absence is allowed during the year but may not be one of the before mentioned days. *

Yes I understand

I understand that no more than ONE session may be missed due to illness, injury or emergency and if more than ONE session is missed I will be dropped from the class without a refund. *

Yes I understand

I understand the tuition of $650 for Denison Chamber members ($900 for future members) is payable prior to the Meet & Greet in late August unless previous payment arrangements have been made. Further, I understand that tuition is non-refundable once I have been accepted into the program, agreed to attend, and the 2023 class has been publicly announced. *

Yes I understand

I understand the legal consequences of signing this document, including releasing the Denison Area Chamber of Commerce from all liability, waiving my right to sue the Denison Area Chamber of Commerce and I assume all risks of participating in the this program, including travel to and from all activities or any events incidental to the program. *

Yes I understand

I understand that my employer (if applicable) must submit the separate Employer Sponsorship Agreement form for my application to be considered complete and forwarded to the Leadership Denison Institute Committee for consideration. *

Yes I understand Not Applicable

Applicant Signature *

By typing your name you understand the above commitments and agree to be bound by them in the signing of this application.

Date and Time *

Format: M/d/yyyy

Leadership Denison Institute Application Class of 2023 - 40 years of EXCELLENCE

Resources

Get in touch

Leadership Denison Institute Application Class of 2023 - 40 years of EXCELLENCE

Resources

Get in touch

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