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2024 Executive Leadership Candidate Application
This form is being previewed. All form submissions will be ignored.
PART ONE: PROFESSIONAL/PERSONAL INFORMATION
NAME
Title
First Name
*
Last Name
*
Suffix
Occupation/Title
*
Employer
*
Employer 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
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Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
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Montana
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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
*
Business Phone Number
*
Personal Information
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
*
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
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 1, 2023
https://www.dcrcoc.org/executive-leadership-program
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