Leadership Rowan Application (2021-2022)
First Name
Middle Initial
Last Name
Work Phone
Preferred Mailing Address
E-mail Address
Employer
Employer Address
Occupation
Optional information needed to ensure diversity of the class)
Age range 20-35
Age range 36-50
Age range 51-65
Age range 65+
Gender
Race
Job Title
Education (degree(s), dates, institutions, etc.)
Community Involvement. Please list (in order of importance) three organiations, i.e. community, civic, professional, religious, social athletic, etc., in which you are or have been a member during the past five years. List any leadership positions and/.or
How did you become aware of Leadership Rowan?
Rowan Chamber
News Media
Social Media
Mail
Other
Why do you want to participate in Leadership Rowan and what do you hope to gain from the program? (Limit of 100 words)
References (Please list two people other than your immediate superviosr or family who are knowlegeable about your leadership performance and potential
Name (Reference 1)
Title (Reference 1)
Company (Reference 1)
E-mail (Reference 1)
Telephone (Reference 1)
Name (Reference 2)
Title (Reference 2)
Company (Reference 2)
E-mail (Reference 2)
Telephone (Reference 2)
Letter of Recommendation Please include one typed (and signed) letter of recommendation with completed application. This recommendation letter can be written by someone listed above as a reference or by your immediate supervisor.
Please email your letter of recommendation to echurch@rowanchamber.com
I understand Leadership Rowan requires a commitment from participants and their employers. Employer Commitment - if applicable. This applicant has the approval of this organization and the applicant has our full support which includes the necessary time required to fully participate in all days and aspects of the program.
Please indicate YES or NO
Immediate Supervisor's Name
Organization
Immediate Supervisor's Signature
Date
Full tuition ($825 for Chamber members and $1,250 for non-members) is due by Fri., July 23 for applicants who are selected and will be paid by:
me personally
my employer
Limited financial assistance may be available for those who need and request it after the selections are made. Do you require financial assistance in order to participate?
yes
no
If yes, please explain:
