Leadership Cape Application Name First Name * Last Name * Please list how you would like your name to appear on printed materials Business * Position * Email * Business phone * Cell number * Cell carrier (for time-sensitive text alerts) * Time spent with current employer * Business address Address Line 1 * Address Line 2 City * State * Select option... Alabama Alaska Arizona Arkansas California Colorado Connecticut DC Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming DC Zip/Postal Code * Education * Select option... High school College education - graduate, post-graduate, doctoral, etc. Trade school Other Advanced or professional training details * Please indicate any advanced training you have received during your career. Head shot (to be used in class directory) Business & professional involvement * Please list all business and professional organizations you are involved with. Community & civic involvment Please list all community/civic organizations you are involved with:. Have you participated in a similar leadership program in another community? * Yes No Three most critical challenges facing Cape Girardeau today * In your opinion, what are the three (3) most critical problems/issues facing Cape Girardeau today? Why do you wish to participate in Leadership Cape? * Please provide a brief statement of the reason(s) you wish to participate in Leadership Cape. What do you expect to gain from participating in this program? * Please provide two (2) professional references other than your current employer. (Name, company, phone) * My tuition will be paid: * Personally By my employer If accepted into the Leadership Cape Girardeau program, you or your firm will be billed for the tuition fee of $595 for Cape Chamber members or $645 for non-Cape Chamber members. Tuition covers supplies, meals, transportation, etc. during the sessions. Tuition must be paid in full by March 2, 2021 and is non-refundable. I have my employer's approval to participate in Leadership Cape. * Yes No Supervisor's name * Supervisor's email * Applicant's e-signature * By submitting this form, • I understand attendance at the class retreat (March 13, 2020) is mandatory and if I miss the retreat, I will no longer be a member of the 2020 Class. • If selected as a participant in Leadership Cape, I am willing to attend all functions sponsored by the program, and I understand attendance is mandatory. • I understand I am to notify Kim Voelker when I am unable to attend a session. • I understand if I miss more than one session, I will need to make up the session(s) the following year in order to graduate. • I understand I will be required to complete a team project which will require an additional time commitment above and beyond regularly scheduled sessions. Participation is mandatory. • I understand, as a leader, I represent my organization and will conduct myself at all times in a professional manner. • I understand if I fail to meet any obligations of the program, I may be asked to withdraw or may not graduate with my class.
