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            • 2024-2025 Youth Leadership Application

              APPLICATION DEADLINE IS JUNE 30, 2024

              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

              Youth Leadership Title Sponsor: Hudson Valley Credit Union

              Program Sponsors: M & T Bank, Royal Carting Service Company and Welsh Sanitation Service
              Graduation Event Sponsor: DCH Wappingers Falls Toyota

              Special Thanks To: Dutchess Community College
              Student's name:
              Address
              Format: M/d/yyyy
              Preferred method of contact *
              Please check one.
              Preferred Pronouns
              Please check one.
              The following questions are used only for statistical purposes:
              Race and Ethnic Identification
              THIS SECTION MUST BE COMPLETED BY A PARENT OR GUARDIAN
              Parent(s)/Guardian(s) Name
              Preferred method of contact *
              Please check one.
              Emergency Contact for Your Child
              Program Fee
              The Youth Leadership 2024-2025 program tuition is $350 for the entire year.
              The deadline to submit payment is August 1st, 2024.
              A limited amount of tuition scholarships are available to students who demonstrate financial need and a strong commitment to leadership on a first-come/first-served basis until funds are depleted.
              STUDENT - Name/Photograph Release
              Press organization and the Dutchess County Regional Chamber of Commerce/The Chamber Foundation, and our partnering presenters and hosts, may write stories on the Leadership Connections Program and/or activities and benefit the youth by displaying their achievements. Please indicate whether you will allow your name and/or photograph released to the press. *
              Please type your name - this acts as your digital signature.
              Format: M/d/yyyy
              PARENT OR GUARDIAN
              Please type your name - this acts as your digital signature.
              Format: M/d/yyyy

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