Leadership Vicksburg 2026–2027 Cohort
Welcome! We are excited that you have an interest in joining the next cohort. The deadline to submit this form is Friday, July 31. The program cost is $500 and typically paid by your employer. If you have any questions, please contact Chris Rials at 601-636-1012 or crials@vicksburgchamber.org.
Applicant Information
Applicant Name
*
First Name
Last Name
Company / Organization
*
Title
*
Mobile Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Highest Level of Education Obtained
*
Please Select
HS Diploma
Some College
Associate Degree
Trade/Technical Degree
Bachelor's Degree
Master's Degree
Doctoral Degree
Other
Supervisor Information & Support
Does your supervisor support your participation in Leadership Vicksburg?
*
Yes
No
Supervisor’s Name
*
Supervisor’s Email
*
example@example.com
Supervisor’s Work Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Program Commitment
Will you take an active role in developing and implementing a community project?
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Yes
No
Attendance Policy Agreement Initials
*
The Leadership Vicksburg program is a shared cohort experience developed and built through regular attendance. In addition, as a contributor to the community project it is vital that you attend class. All participants are expected to attend Orientation, the Retreat and all other meeting times. We understand emergencies occur and exceptions will be considered on a case-by-case basis. If you miss more than two classes, you will not be eligible to graduate.
Preferences & Special Needs
Food allergies and/or dietary restrictions
*
If you don't have any food allergies, please type N/A.
Polo shirt size
*
Please Select
XS
S
M
L
XL
XXL
XXXL
Other
Essay Questions
Why are you interested in participating in the Leadership Vicksburg program?
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In your opinion, what is one pressing issue that exists in Vicksburg–Warren County and more importantly what steps would you take to correct it?
*
Billing / Tuition Information
Employer name for invoice
*
Employer email address for invoice
*
example@example.com
Submit Application
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