Leadership Northfield Application 2024-25 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 * 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? * 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 How did you hear about Leadership Northfield? * Chamber E-Blast/Newsletter Supervisor Chamber Board Member Professional colleague/associate Directory Mailing Other