Leadership Salkehatchie Application

Permanent Contact Information

This information will be used to contact you for future alumni events. This should be information that will not change if you should leave your job.
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Describe your education, training, or certifications
List any government, civic, professional, business, social, or athletic organizations, boards or commissions in which you are a member or have participated on. Please specify any leadership roles held.
Please describe your 3 most significant professional and/or civic accomplishments.
In 250 words or less, tell us why you want to participate in Leadership Salkehatchie and what you hope to gain from this program. In addition, outline the areas of greatest concern that you see confronting the Salkehatchie region and how you hope to address them.
I am aware of the time commitment involved with Leadership Salkehatchie. I understand that each participant must be committed to attendance, punctuality, and participation in all activities – including a class project, which often meets after sessions or at other times as determined by the class at large.
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Permanent Contact Information