2024 Executive Leadership Candidate Application

PART ONE: PROFESSIONAL/PERSONAL INFORMATION

NAME

Title

First Name *

Last Name *

Suffix

Occupation/Title *

Employer *

Employer Address

Address Line 1 *

Address Line 2

City *

Zip/Postal Code *

Business Phone Number *

Business Email Address *

Personal Information

Address Line 1 *

Address Line 2

City *

Zip/Postal Code *

Home Phone Number *

Cell Phone Number *

Home email *

Preferred "first and last name" to be used on name tag *

Please attach a current resume to include education and professional background *

PART TWO: GENERAL QUESTIONS

Why are you enrolling in the Executive Leadership Program? What do you hope to gain from this program? *

Please list/explain other leadership training that you have completed *

How did you learn about the Executive Leadership Program? *

Business Friend Leadership Dutchess Alumni Website Chamber event Other

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. To qualify you must live or work in Dutchess County or for a member of the Dutchess County Regional Chamber of Commerce. Please attach a 500 word essay expressing how the program will help you advance your professional career, incorporate your sentiments on what defines a great leader. In your essay, articulate in 100 additional words the financial need for this scholarship. The applicant’s school or employer must be a member of the Dutchess County Regional Chamber of Commerce. You must establish a financial need and desire to participate in this program. 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

If you are not awarded the Charles S. North Leadership Advancement Scholarship, will you still have the ability to participate in the program? *

Yes No

PART THREE: EMPLOYER RECOMMENDATION FORM

(if you are a sole proprietor, or do not have an employer that you report to, please request a personal recommendation form in place of this form by emailing foundation@chamberfdn.org).

The Executive Leadership Program is designed for mid- to senior-level managers and entrepreneurs seeking advanced leadership, strategic planning and communications skills to move their careers and organizations forward. This program focuses on topics critical to the success of individuals in organizations of all kinds, including large and small for-profit companies, governmental agencies, healthcare, and not-for-profit organizations. The program is sponsored by The Chamber Foundation, Inc. A recommendation by the employer is a required part of the application process. Your responses will be kept strictly confidential.

The recommendation also includes a commitment by the employer that the employee will be released from work responsibilities for scheduled program sessions.

Please have your employer fill out the form from the website link below and return in a sealed envelope to The Chamber Foundation, Inc., One Civic Center Plaza, Suite 400, Poughkeepsie, NY 12601 on or before December 2, 2023

https://www.dcrcoc.org/executive-leadership-program

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