Rocky Mount Chamber LTC Application 2027

Cohort Overview:
The Chamber's Leadership Class is an eight-month cohort designed to develop informed, connected, and engaged community leaders. Participants meet once a month at various locations throughout the Twin Counties to explore key aspects of our region and engage in meaningful discussions about leadership and community impact.
SECTION 1 — Applicant Information
Name:
Preferred Name (if different):
Employer/Organization:
Job Title/Position:
Work Address:
Phone:
Format: (000) 000-0000.
Email:
example@example.com
Years living or working in the Twin Counties:
SECTION 2 — Professional Background
1. Briefly describe your current role and main responsibilities:
2. Summarize your professional and/or educational background:
3. What do you consider your greatest professional accomplishment so far?

SECTION 3 — Community Involvement
List any community organizations, boards, or volunteer activities you are involved in:
What issues or opportunities in the Twin Counties are you most passionate about?
How do you see yourself contributing to positive change in our community?
SECTION 4 — Leadership & Personal Growth
What does leadership mean to you?
Describe a situation where you demonstrated leadership (formal or informal):
What skills or qualities do you hope to strengthen through this cohort?
How do you plan to apply what you learn to benefit your organization or community?
SECTION 5 — Cohort Investment
Participation in the Chambers Leadership Class requires a $1,000 tuition fee, which covers cohort materials, meals, and session expenses.
Tuition may be paid by:
- The participant
- The participant's employer
- A community sponsor

Payment details will be provided upon acceptance into the cohort.
Please indicate your payment source:
If a sponsor or employer will be paying, please provide their contact information:
Name:
Organization:
Phone/Email:
Acknowledgment:
I understand that if selected for the Chambers Leadership Class, I am responsible for ensuring payment of the $1,000 tuition prior to the start of the cohort.
Signature:
Date:

MonthDayYear
Date
SECTION 6 — Cohort Commitment
The Leadership Class meets once per month for eight months. Full participation is essential for a successful experience.
Please confirm:
(Optional) Employer's/Supervisor's Signature:
Title:
Date:

MonthDayYear
Date
SECTION 7 — Additional Information
How did you hear about the Chambers Leadership Class?
Industry/Sector (Business, Nonprofit, Government, Education, etc.):
Years in the workforce:
Submit Your Application
Applications are due by January 8, 2027.
Please return completed forms to Taylor Anderson at tanderson@rockymountchamber.org.
Selected applicants will be notified by January 30, 2027
Should be Empty: