2023-2024 Leadership Dutchess Application

APPLICATION DEADLINE IS JUNE 30, 2023

The Chamber Foundation, Inc.
One Civic Center Plaza, Suite 400
Poughkeepsie, NY 12601
845.454.1700 ext. 1025
Fax: 845.454.1702
foundation@chamberfdn.org

Program Sponsors:
Central Hudson
The Children’s Home of Poughkeepsie
KeyBank
RBT CPA’s
Ulster Savings Bank

PROFESSIONAL INFORMATION

Participant's Name:

Title

First Name *

Last Name *

Suffix

Occupation/Title: *

Employer: *

Business Address:

Address Line 1 *

Address Line 2

City *

Zip/Postal Code *

Business Phone: *

Immediate Manager's Name: *

Immediate Manager's Phone: *

Immediate Manager's Title *

If another organization, please list name:

The Charles S. North Leadership Advancement Scholarship

In recognition of the outstanding leadership of Dutchess County Regional Chamber Commerce Past President and CEO Charles S. North, a scholarship was established in 2014 upon his retirement. Awarded to any individual living or working in Dutchess County, the Charles S. North Leadership Advancement Scholarship signifies Mr. North’s commitment to inspiring and mentoring leaders across the region. See complete details on how to apply at www.dcrcoc.org/scholarships Full and/or partial scholarships will be awarded.

Are you applying for the Charles S. North Leadership Advancement Scholarship?

Yes No

PERSONAL INFORMATION

Preferred name as you'd like it to appear on name tag: *

Home Phone: *

Cell Phone: *

Home Address:

Address Line 1

Address Line 2

City

Zip/Postal Code

Personal Email: *

Preferred email to be used for program communication: *

Please attach a current resume to include educational and professional background.

GENERAL QUESTIONS

How many years have you lived/worked in the Dutchess County area? *

List some of your past accomplishments (at work and outside of work): *

Please list/explain other leadership training that you have received: *

List some community organizations in which you were or are actively involved, and/or any boards you participate or participated in (community, civic, professional, business, religious, social, athletic, or other.) List the role that you play in each. *

What are your career goals? *

Where do you see yourself in 5 years? *

How did you learn about Leadership Dutchess? *

Business Newspaper Friend Leadership Dutchess alumni Website Other

If other, please explain:

ESSAY

Leadership Dutchess is a program designed to foster the development of your personal leadership skills. By examining your weaknesses, and improving existing strengths, you will learn how to utilize and implement leadership skills most effectively. Tell us about a challenge you encountered, personally or professionally, where your leadership skills were not sufficient. Describe what happened and how you believe the Leadership Dutchess program will help you overcome those deficiencies.

Upload essay file *

Please attach your response. Responses should be limited to 500 words (two pages, double spaced).

Participant Signature *

Please type your name - this acts as your digital signature.

Date of signature *

Format: M/d/yyyy

EMPLOYER RECOMMENDATION FORM

PLEASE REMEMBER TO FILL OUT THE EMPLOYER RECOMMENDATION FORM SEPARATELY. View this form at www.dcrcoc.org/leadership-dutchess-program