Leadership Manitowoc County Application

Leadership Manitowoc County Application
Leadership Manitowoc County (LMC) is a community engagement program that brings
together potential leaders who will be encouraged, motivated and prepared to assume more influential roles as leaders of Manitowoc County.

Applications will be accepted until the class is full (limited spots are available).

For additional information, please call The Chamber office, (920) 684-5575 or email melissa@chambermanitowoccounty.org.
Full Name

First NameLast Name
Date of Birth

MonthDayYear
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mobile Number
Email Address
Years in the Manitowoc County area
Do you have any allergies (or food restrictions), to foods, plants or insects; sensitivity to sunlight, etc.? If yes, please explain:
Explain
Is your Employer/Organization a member of The Chamber of Manitowoc County?
Employer/Organization Name
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Work/Employer/Organization Phone Number

Area CodePhone Number
Job Title
Will your job allow you to participate fully in the program?
Do you have support of your employer for the time required to participate in Leadership Manitowoc County?

Experience, Organizations and Activities
What do you consider your highest responsibility, skill, or career achievement to date?
Special awards or honors for academic or work performance
List, in order of importance to you, up to three organizations in which you have been or are currently active. (Include organization name, date range when you participated, and office/position held)
What was your most significant responsibility, challenge, and accomplishment during your participation in the above organizations?

Applicant’s Personal Statement
Why do you want to participate in Leadership Manitowoc County?
What challenge(s) do you perceive Manitowoc County is facing today? Describe how you would address them and what are your recommendations for solutions?
Describe the positive aspects of living and working in Manitowoc County.
Current hobbies and interests
Is there anything else you would like to note about yourself or your experience that would aid in the selection process?
Please submit a headshot for our program materials

Browse Files

Cancelof

Commitment
One full weekday on the third Wednesday of each month - September through May. I understand the purposes of the Leadership Manitowoc County program and if I am selected, I will devote the time and resources necessary to complete the program. Attendance, all day, every day, at all monthly sessions, is critical to the understanding of the program and to the members of the class. Absences for personal or professional reasons must be approved in advance by The Chamber Executive Director. Absences must be reported to The Chamber of Manitowoc County by 7:45 a.m. on the morning of a scheduled Leadership Manitowoc County day. More than two (2) absences may be reason for dismissal from the program with no portion of the tuition to be refunded. Attending only partial days are not permitted, unless approved by the Executive Director, and/or in case of an emergency. I understand the above commitments and agree to be bound by them in signing this application.
Acknowledgment of Activities & Assumption of Risk

I understand that the Program may include, but is notlimited to: Transportation by bus or other vehicle to and from program sites; Visits to corporate facilities, manufacturing sites, offices, and other business locations; Light physical activities, team-building exercises, and interactive programming; Walking tours, use of stairs, and movement through active workplace, etc. I understand these activities involve inherent risks, including but not limited to: Motor vehicle accidents; Slips, trips, and falls; Injuries resulting from physical activity; Exposure to industrial or workplace environments; Illness, serious bodily injury, permanent disability, or death, etc. I knowingly and voluntarily assume all risks, both known and unknown, arising from my participation.
Release and Waiver of Liability

To the fullest extent permitted by law, I release and hold harmless the Chamber of Manitowoc County, its officers, directors, employees, volunteers, agents, sponsors, transportation providers, host businesses, and affiliated partners from any and all claims, liabilities, damages, or causes of action arising out of or related to my participation in the Program, including claims based on alleged negligence.
Indemnification
Medical Authorization
Photo/Media Release
Acknowledgment
Applicant's Signature

Tuition

Sponsor to fill out, if applicable
Member $749 or Non-Profit Member $349
Non-Member $1498 or Non-Profit Non-Member $698

*Please note that all tuition fees are nonrefundable.

If the applicant changes employers before completing the class, it will be up to the employer that paid the tuition's discretion whether the applicant may continue in the program.
If accepted into the Leadership Manitowoc County program, who should The Chamber of Manitowoc County bill for the tuition? Name:
Are you a 501(c)(3) non-profit organization who is in need of financial assistance to participate in the program?
If Yes, and you are selected, a representative of Leadership Manitowoc County will contact you.You are encouraged to seek a sponsor if your employer is not paying the tuition.
Name of Sponsor/Direct Report (person to be invited to the graduation ceremony)
Sponsor/ Direct Report Title
Sponsor/ Direct Report Email
example@example.com
If the applicant changes employers before completing the class, it will be up to the employer that paid the tuition's discretion whether the applicant may continue in the program. Tuition is not refundable.
This applicant has the approval of this organization and the applicant has our full support to participate in the program
Should be Empty:

Leadership Manitowoc County Application

Experience, Organizations and Activities

Applicant’s Personal Statement

Commitment

Tuition