Leadership Connect Application

Leadership Connect Application

2025-2026
Name*

First NameLast Name
Title*
Company*
Phone*
Email*
Supervisor's Name & Title: *
Community Involvement
Are you involved in any professional or community organizations? If yes, please share the organization name, and describe involvement. *
Summarize how you would use your experience after the program to benefit your employer, your community, and yourself? *
Describe any leadership opportunities you have had thus far. What have you learned from those experiences?*
Please share any special awards, honors, extracurricular activities, and any leadership activities you've been involved in previously. *
Reference #1

One employment related reference and one personal reference
Is this a personal or professional reference?

PersonalProfessional
Name*

First NameLast Name
Title*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Reference #2

One employment related reference and one personal reference
Is this a personal or professional reference?

PersonalProfessional
Name*

First NameLast Name
Title*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Commitment
Attendance at a 2-day retreat in September, day-long sessions, held each month, October through April, and a graduation program in May, are mandatory. 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.
Acknowledgement
Tuition for Leadership Connect is $2500 per participant and is payable at the time of acceptance to the program. Tuition is payable to the Northwest Ottawa County Chamber Foundation and is deductible under the Internal Revenue Service Code as a business expense. A limited number of partial scholarship 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.

I have discussed with my supervisor my intention to participate in the Leadership Connect program. I understand that attendance at all scheduled 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 Leadership Connect Program.

I understand that $2500 tuition is non-refundable and is due at the time of acceptance.

Submitted Leadership Connect Applications will be reviewed by the committee and applicants will be notified of their acceptance status via email.
Date*

MonthDayYear
Date
I understand the acknowledgement above*

Yes
I have reviewed the time commitment to engage with Leadership Connect with my supervisor and have their full support to participate in the program and each of the day sessions*

Yes
Supervisor Name:*

First NameLast Name
Supervisor Phone Number *
Please enter a valid phone number.
Supervisor Email*
example@example.com
Should be Empty:

Leadership Connect Application

Community Involvement

Reference #1

Reference #2

Commitment

Acknowledgement