Suffolk 360 Application for Enrollment

Suffolk 360 Application for Enrollment
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Current Employer
Job Title

Eligibility
Do you live or work in Suffolk?
How many years have you lived or worked in Suffolk?

Please list any civic, professional, volunteer, faith-based, nonprofit, neighborhood, or community organizations in which you participate.

Please describe any leadership roles you have held in your workplace, community, school, volunteer organizations, military, or other settings.

Why are you interested in participating in the Suffolk Leadership Program?

0/250
What do you believe is one of Suffolk's greatest strengths?

0/250
What is one opportunity or challenge facing Suffolk that you would like to better understand?

0/250
How do you hope to use what you learn through this program to make a positive impact in Suffolk?

0/250

COMMITTMENT
There are seven evening sessions over approximately three months. The sessions are held every other Tuesday from 6:30 p.m. – 8:00 p.m.

Session dates are as follows:
- September 19
- September 29
- October 13
- October 27
- November 10
- December 1
- December 15
I acknowledge the following:
PROGRAM INVESTMENT

Participation in Suffolk 360 requires a $50 program fee, payable upon acceptance into the program.

The program fee supports the cohort's Community Impact Project. As part of the program, participants will work together to identify a local nonprofit or community organization and present a collective donation in support of its mission, leaving a lasting impact on the Suffolk community.

By participating in Suffolk 360, you are investing not only in your own leadership development, but also in giving back to the community you serve.
I acknowledge the following:
Does your employer support your participation?
Should be Empty: