Leadership Northfield Application 2023-24

Name

First Name *

Last Name *

Company *

Company Address

Address Line 1 *

Address Line 2

City *

Zip/Postal Code *

Work Phone Number *

Email Address *

Cell Phone Number *

References: List your immediate supervisor and at least one other person who may be contacted by the selection committee.

Supervisor Name

First Name *

Last Name *

Title & Company *

Phone Number *

Reference Name

First Name *

Last Name *

Title & Company

Phone Number *

GENERAL INFORMATION:

Please answer the following questions.

Describe a professional or community leadership challenge you have undertaken. *

What do you think is a significant challenge facing the Northfield area today? *

What strengths would you bring to Leadership Northfield? *

In what ways do you think Leadership Northfield can help you develop your leadership potential? What do you expect of the program? *

Upload Current Resume.

Enclose a resume. Include degrees awarded, fields of study, professional institutes, training programs, etc. List professional affiliations, community, religious, athletic and social organizations with which you have been or are currently active.

Are you willing to commity to nine sessions to attend Leadership Northfield? *

Yes, I can commit to all nine sessions No, I can't commit to all nine sessions

Who Will Be Paying Your Tuition? *

Me My Employer A Sponsoring Organization Scholarship Requested

Is your business/company a member of the Northfield Area Chamber of Commerce & Tourism? *

Yes - $700 No - $1000 Unsure

How did you hear about Leadership Northfield? *

Chamber E-Blast/Newsletter Supervisor Chamber Board Member Professional colleague/associate Directory Mailing Other

Leadership Northfield Application 2023-24

Affiliations

Northfield Chamber of Commerce & Tourism

Community Partners