Bismarck-Mandan Chamber of Commerce: Leadership Bismarck-Mandan : Program Application

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Program Application

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Program Application

Leadership Bismarck-Mandan Application Thank you for your interest in Leadership Bismarck-Mandan. Our mission is to engage emerging leaders in business and community issues. You're invited to complete the following application. Once complete, you will be prompted to provide your direct supervisor and one other reference with a website address to complete a letter of support for you within 10 days. Once all application materials are received, our selection team will begin choosing the program participants. If you would like a copy of your application, print this page BEFORE you hit submit.
* 1. First Name
* 2. Last Name
* 3. Home Address
* 4. City
* 5. Number of Years Lived in Bismarck-Mandan
* 6. Education
* 7. Present Employer
* 8. Work Address
* 9. Work Phone
10. Work Fax
* 11. E-mail Address
* 12. Job Title
* 13. Date Hired
* 14. Please indicate your previous two employers.
* 15. What do you consider as your most important career achievement/skill/responsibility to date?
* 16. Please list the civic, business, social or religious activities you have participated in during the past five years. For each, indicate the extent of your involvement, offices held, awards received or special recognition given. If you have not been involved in such activities, please explain why.
* 17. Please provide a brief bio that summarizes in two paragraphs your current employment, responsiblities and civic involvement.
* 18. Would you give the Chamber permission to publish your bio as part of Leadership Bismarck-Mandan news in their print and electonic communications?	Yes No
* 19. Would you give the Chamber permission to publish photos taken of you during the Leadership issue days and events?	Yes No
* 20. What do you feel are the two most significant business or community issues facing Bismarck-Mandan?
* 21. What can you contribute to the Leadership Bismarck-Mandan program?
* 22. What do you think it takes to be a future leader engaged in business and community issues?
* 23. How would you evaluate yourself against the response from the last question?
* 24. What would you hope to gain from your participation in Leadership Bismarck-Mandan?
* 25. How do you envision Bismarck-Mandan five years from now?
* 26. How do you plan to be engaged in business and community issues five years from now?
* 27. Leadership Bismarck-Mandan requires participation at all sessions with no more than one absence allowed. In addition, participants must complete field projects, which will require some out-of-class work (anywhere from 10-20 hours). Are you able to fulfill this commitment?	Yes No
* 28. Please type your full name in the space provided as acknowledgement of the following statement and to serve as an electronic signature for your application. I understand the purpose of Leadership Bismarck-Mandan and the commitment required. If I become a participant, I will devote the required time/energy needed to fulfill that commitment. I also will demonstrate courtesy by arriving on time to issue days and after breaks and by not conducting business unrelated to issue days during class.

Copyright 2009 Bismarck-Mandan Chamber of Commerce
1640 Burnt Boat Drive * PO Box 1675
Bismarck, ND 58502-1675
info@bismarckmandan.com
701.223.5660

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