West Coast Leadership Application

West Coast Leadership Application 2022-23

Your application must be received no later than 5:00 pm on Friday, May 6, 2022. Applicants to the West Coast Leadership Class of 2022-23 will be notified of their selection status no later than June 10, 2022. Please contact Jodi@westcoastchamber.org or (616) 928-9102 with any questions.
Name

First Name Last Name
Home Address *

Street Address

Street Address Line 2

City

Postal / Zip Code
Birth Date *

Month Day Year
Years in the Holland/Zeeland area: *
Work Phone Number *

Area Code Phone Number
Cell Phone Number *

Area Code Phone Number
Email *
example@example.com
Ethnicity *

African American Asian Caucasian Hispanic Middle Eastern Native American Other Prefer not to answer
Employment
Current Employer: *
Current Title: *
Date Hired: *

Month Day Year
What industry best describes your current employer? *

Education Government Health Care Hospitality/Tourism IT/Engineering Law Media/Marketing Manufacturing Non Profit Real Estate / Insurance / Finance Religion Retail Social Services

Previous Employment: *

	Employer	Title	Dates From-To
Previous Employer
Previous Employer
Previous Employer

Does your job require you to travel? *

Yes No
If yes, how many days per month does your work require you to be out of the area?
Education

List college(s), business or trade schools and/or other specialized training *

	School	Dates From - To	Degree	Major
Education
Education
Education
Education

Organizations / Activities

Please list, in order of importance, up to five community, civic, professional, business, religious, social, or other organizations of which you are or have been involved in. *

	Organization	Dates of Involvement	Type of Involvement
1
2
3
4
5

What have you accomplished with these organizations or activities that you think is important? *
How much time each month do you commit to community, civic, professional and other organizations and activities?
Applicant's Statement
What are you hoping to accomplish by your participation in West Coast Leadership? *
What unique attributes, viewpoints, or experiences will you contribute to the make up of the class? *
Please choose an issue facing the Holland/Zeeland community and provide your viewpoint. What solutions would you suggest for addressing the issue? *
How do you expect the Holland/Zeeland area will benefit from your successful completion of the program? *
Tuition / Funding and Financial Assistance

Tuition for the West Coast Leadership Program is $3,000 per participant for Chamber members and $4,000 for non-members, and is due by August 5, 2022. Tuition is payable to the Michigan West Coast Chamber of Commerce and is deductible under the Internal Revenue Service Code as a business expense.

To assure the diversity of the program, a limited number of partial scholarships may be extended to qualified individuals who may not otherwise be able to participate. Once the applicant is accepted, requests for scholarship assistance will be considered on the basis of demonstrated need and class composition.

Financial assistance is also available through a payment plan arrangement, in which the tuition is paid over an extended period of time, with the full payment payable by December 31, 2022.
Will you need financial assistance to participate in the program? *

Yes No
Scholarship Amount Requested:
Reason:
Payment Plan Request and Reason:
Commitment

Attendance at Orientation on August 24, 2022, a 2-day retreat on September 14-15, 2022, 7 day-long sessions, held on the 2nd Wednesday of every month, October through April, and a graduation program on May 17, 2022 are mandatory. An additional 6-7 hours of outside learning experiences are required. Persons who cannot adjust their schedules to accommodate these 10 days should not apply. Class Members are expected to attend each day session in its entirety.
Are you and your employer willing to make such a commitment? *

Yes No
I understand that the format of each day may vary based on the recommendation of the Health Department at the time of the scheduled program. Programming may include any combination of in person small groups, full class in person, online via Zoom, or other possible options not listed. Full participation is expected regardless of format. *

Yes No
Acknowledgement

I understand that there is a significant time and financial commitment required to participate in the West Coast Leadership Program and have received the support and approval of my supervisor to fully engage in the program. I understand that attendance at all scheduled West Coast Leadership sessions is mandatory, because my participation is essential to the program's success. I have reviewed with my supervisor the program schedule and have received permission to be absent from work on all scheduled dates. I have also discussed with my supervisor the importance of my participation in each session and that absence could result in my dismissal from the West Coast Leadership program. If for some reason I must withdraw from West Coast Leadership, notification must be given to the West Coast Leadership Director no later than July 31, 2022. If notification is given later than that, a $500 fee will be charged. No refunds will be given after August 24, 2022.
Applicant Signature *

Clear
Supervisor Name: *

First Name Last Name
Supervisor Email: *
example@example.com
Supervisor Phone Number: *

Area Code Phone Number
Selection Criteria

West Coast Leadership is designed to bring together new, emerging and established leaders from the area to learn about and address pertinent community needs, strengthen individual leadership abilities to help the community respond to changing needs new opportunities and encourage participants to personally commit to assuming leadership roles in the community. Participants will have diverse backgrounds in terms of gender, race, age, occupation and community grouping.

Participants are selected on the basis of: Demonstrated community involvement; Present or potential leadership role in an organization relative to age and experience; Ability and interest to complete the West Coast Leadership program and to contribute to the Holland/Zeeland community in the future.
Submitting Your Application

Your application must be received no later than 5:00 pm on Friday, May 6, 2022. Applicants to the West Coast Leadership Class of 2022-23 will be notified of their selection status no later than June 10, 2022. Please contact Jodi@westcoastchamber.org or (616) 928-9102 with any questions.
Should be Empty:

West Coast Leadership Application 2022-23

Applicant's Statement