Leadership Northfield Application 2023-24 The selection committee will choose participants based on their responses to the following questions. Please answer as completely as possible. Name First Name * Last Name * Company * Company Address Address Line 1 * Address Line 2 City * State * Select option... Alabama Alaska Arizona Arkansas California Colorado Connecticut DC Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming DC 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