Leadership Application Class of 2026

I. Personal Information and Demographics

Demographics are requested in order to provide aggregate data to program sponsors and grant funders that make this program possible. NOTE: Name, email, and DOB are required for program application. Providing demographic information is optional and does not affect your eligibility or consideration for program participation.

Name *

First

Last

Name for name badge, if different (i.e. nickname)

Email *

Preferred Phone Contact *

Cell Phone
Work Phone

Date of Birth *

MM/DD/YYYY Participants must be 21 years of age or older.

Gender

Town/City of current residence *

Years in Eastern CT *

Any dietary restriction or food allergies?

For meal planning

Are you of Hispanic, Latino, or of Spanish origin?

Yes
No
Prefer not to answer

Citizenship Status:

U.S. Citizen
Dual Citizen (U.S. and Other)
Non-U.S. Citizen

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II. Employment

Current employer *

Business Address

Address Line 1

Address Line 2

City

State

Zip Code

Title *

Current employment start date *

MM/DD/YYYY

Briefly describe your responsibilities. *

What would you consider your highest responsibility or career achievement so far? *

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III. Education

School Name

School Location

Graduation Year

Degree

School 2 Name

School 2 Location

Graduation Year

Degree

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IV. Organization/Activities/Community Involvement

Please explain your community engagement role(s), and identify any leadership responsibilities or areas where you have managed projects, people, and/or processes (event chair, project chair, fundraising chair, board of directors, PTO/PTA, etc.).

Primary volunteer role at this time

Organization

Position

Dates Served

MM/DD/YYYY - MM/DD/YYYY

Responsibilites

Other volunteer, professional, civic, etc. roles

Please list in order of importance to you, any other community, civic, professional, business, social, athletic, and other organizations of which you have been a member.

Organization 1

Position

Dates Served

MM/DD/YYYY - MM/DD/YYYY

Organization 2

Position

Dates Served

MM/DD/YYYY - MM/DD/YYYY

What have you accomplished as a leader in any of these activities that you feel is important?

Please list any special awards or accolades.

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V. General

Please be thoughtful and detailed in your responses. A qualifier for program acceptance is a demonstrated capacity for leadership, and (in addition to the above sections) this section provides additional opportunities to highlight your skills, your willingness to learn and be engaged, voice your community concerns, and more.

How would you describe your leadership style? *

What do you feel is a strength of yours? What do you feel is a weakness that you wish to improve? *

What are your areas of particular interest for leadership involvement? *

Identify and discuss a particular issue, opportunity, or problem crucial to the Eastern CT community. *

What do you hope to gain, and how do you expect to utilize your Leadership Program experience? *

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VI. Schedule

The program requires total participation in the sessions during Year One every second Thursday, from approx. 8 AM to 4 PM. During Year Two, participants will plan a minimum of one session in small groups. See section VIII for more participation expectations. ORIENTATION 9/12/2024; HEALTH & HUMAN SERVICES 10/10/2024; EDUCATION 11/14/2024; ECONOMIC DEVELOPMENT 12/5/2024; DIVERSITY EQUITY & INCLUSION 1/9/2024, LEADERSHIP DEVELOPMENT 2/13/2025; GOVERNMENT 3/13/2025; MILITARY AFFAIRS 4/10/2025: TOURISM, ARTS, & TRANSPORTATION 5/8/2025; RETREAT 6/12/2025

VII. Community Project

In addition to the class days listed above, your participation as a team member in a class project is also a requirement of the program. Participants will select, plan, and execute a civic service project in conjunction with a Chamber member nonprofit organization. It must be completed in the first year of the program (Sept-June). The project allows participants to put into action the lessons and leadership skills they will have learned, while leaving a lasting impact on the local community. Parameters of the project are developed by the participants, but scope may include fundraising, drives, and a hands-on aspect such as refurbishing a building or hosting an event. Planning time will be built into each session to the extent possible based on session agendas, however time may still be required outside of class dates. Time commitment varies for each project.

VIII. Participation

In order for our program to accomplish its stated goals, a two-year commitment and full participation of each individual is necessary. Graduation from the program will be contingent on completion of both years. If a participant fails to complete the course for any reason, tuition will not be refunded. Class guidelines include: YEAR ONE: Full participation in the curriculum is a requirement for graduation. - More than three full-day absences, counted in half-day increments during the program year, will result in expulsion from the program. - Participation in a productive manner in a class project is required. See VII. YEAR TWO: Participants will be assigned to at least one planning committee for the sessions of the following year’s program. - A participant is expected to attend session planning meetings with their respective committee(s), as well as attend those designated sessions. - A graduation ceremony and reception will be held in June of year two.

I have read the expectations of participation as stated in sections VI-VII and agree to the required level of commitment to make the most of this program. *

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IX. Tuition

Participation in the LEADERSHIP EASTERN CT two-year program cost a total of $1,125. An invoice will be sent to the email you provided in this application upon acceptance to the Program. Tuition is non-refundable and must be paid prior to October 10, 2024. Make checks payable to Chamber of Commerce of Eastern CT.

PILLARS OF THE COMMUNITY SCHOLARSHIP - Generously Sponsored by the Chamber of Commerce of Eastern CT Regional Benefactors

Click or drag a file to this area to upload.

Partial scholarships are available for applicant(s) employed by a small business (under 15 total FTE employees), and applicant(s) employed by a non-profit, not-for-profit, or municipality. Please submit a letter of request along with this application, which shall include how this program would benefit you and your organization, any personal community involvement not already outlined in the application, and whether you are able to participate in the program should you not be selected for a partial scholarship. Requests for financial assistance do not affect consideration for acceptance.

Who will pay your tuition? *

My Employer
I will pay
Other

Do you have the support/endorsement of your immediate or relevant supervisor for your full participation in the program?

Yes
No
Not applicable, I do not have a supervisor

Supervisor

This person will be notified of your satisfactory acceptance to, and subsequent completion of the program. If you do not have a supervisor (i.e. executive director, president, single employee/owner) you may put "none" or share a board contact here.

Name *

First

Last

Title

Email *

Leadership Eastern CT - Class of 2026 Application

I. Personal Information and Demographics

II. Employment

III. Education

IV. Organization/Activities/Community Involvement

Primary volunteer role at this time

Other volunteer, professional, civic, etc. roles

V. General

VI. Schedule

VII. Community Project

VIII. Participation

IX. Tuition

Supervisor