Leadership Cayuga Class of 2020 Application

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* 1. Applicant Information

First Name

Last Name

Nickname

Home Street Address

Home City, State, Zip

Home Email

Home Phone Number

Cell Phone Number

Number of Years in Cayuga County

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* 2. Current Employer Information

Business/Organization Name

Business/Organization Address, City, State, Zip

Work Email

Work Phone Number

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* 3. Where do you prefer to be contacted?

Home

Work

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* 4. AGE: Completing this section is optional; Leadership Cayuga uses this information for the purpose of ensuring diversity of the class.

Under 18

18-24

25-34

35-44

45-54

55+

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* 5. GENDER: Completing this section is optional; Leadership Cayuga uses this information for the purpose of ensuring diversity of the class.

Male

Female

Prefer Not to Say

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* 6. RACE/ETHNICITY: Completing this section is optional; Leadership Cayuga uses this information for the purpose of ensuring diversity of the class.

White or Caucasian

Black or African American

Hispanic or Latino

Asian or Asian American

American Indian or Alaska Native

Native Hawaiian or other Pacific Islander

Another race

Prefer not to answer

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* 7. EMPLOYMENT: (Employment is not a requirement for acceptance into the Leadership Cayuga program.)
Which of the following best describes your current employment/activity?

Arts

Business/Industry

Clergy

Education

Healthcare

Law

Media

Non-Profit

Self-Employed

Retired

Student

Other

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* 8. Current Job Title:

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* 9. Job Responsibilities:

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* 10. EMPLOYMENT HISTORY: List your past 3 positions held. (Employer; Title or Responsibility; Dates of Employment)

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* 11. EDUCATION: Please List applicable name of school and dates attended.

High School - Name of School and Dates Attended

Undergraduate Degree - Name of School, Dates and Major

Graduate Degree - Name of School, Dates and Major

Technical School/Specialized Training

Other

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* 12. COMMUNITY INVOLVEMENT: Describe your community activities and involvement below. What community service or activities would you like to pursue in the future?

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* 13. ACCOMPLISHMENTS: What do you consider your highest responsibility, skill or career achievement to date?

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* 14. GOALS: What do you hope to gain through your participation in Leadership Cayuga?

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* 15. COMMUNITY: What do you think is the most significant challenge(s) facing Cayuga County?

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* 16. PROGRAM REQUIREMENTS: Leadership Cayuga is a nine month program. The program begins with an Orientation in September and continues with monthly, full day sessions concluding with a Graduation Luncheon at the end of the program. Participants are expected to attend the orientation, graduation, all sessions, and participating as a contributing member of the class. Unavoidable absences will be addressed on a case-by-case basis. Participants who do not fulfill their obligations may not be permitted to graduate.

I have read and understand the goals and commitments required of Leadership Cayuga. I understand that if I fail to meet these obligations I may not be permitted to graduate and will not receive a refund of my tuition.

Please type your full name.

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* 17. TUITION: Tuition for Leadership Cayuga covers the retreat, county bus tour, two Chamber luncheons, graduation and all sessions and program materials. Tuition is $1200* Chamber members receive a $100 discount. Tuition is due within 30 days of acceptance notice. Forms of payment: company check, personal check, VISA or MasterCard.

*Note: All completed applications received before August 15th will receive a $100 discount.

I am responsible for the $1,200 tuition fee

I would like to be considered for a partial sponsorship for tuition. (Please respond below with details)

My employer/sponsor is responsible for tuition.

Scholarship Application Details

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* 18. If accepted, nominee for Leadership Cayuga program must have the support of their employer because of the time commitment involved.

I certify that my employer/sponsor is aware of my Leadership Cayuga application and supports my effort to be a part of this class.

Please Enter your Full Name

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* 19. Please enter your supervisor's name and contact information.

Supervisor Name

Supervisor Phone Number

Supervisor Email

Leadership Cayuga Class of 2020 Application

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* 1. Applicant Information

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* 2. Current Employer Information

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* 3. Where do you prefer to be contacted?

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* 4. AGE: Completing this section is optional; Leadership Cayuga uses this information for the purpose of ensuring diversity of the class.

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* 5. GENDER: Completing this section is optional; Leadership Cayuga uses this information for the purpose of ensuring diversity of the class.

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* 6. RACE/ETHNICITY: Completing this section is optional; Leadership Cayuga uses this information for the purpose of ensuring diversity of the class.

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* 7. EMPLOYMENT: (Employment is not a requirement for acceptance into the Leadership Cayuga program.)Which of the following best describes your current employment/activity?

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* 8. Current Job Title:

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* 9. Job Responsibilities:

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* 10. EMPLOYMENT HISTORY: List your past 3 positions held. (Employer; Title or Responsibility; Dates of Employment)

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* 11. EDUCATION: Please List applicable name of school and dates attended.

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* 12. COMMUNITY INVOLVEMENT: Describe your community activities and involvement below. What community service or activities would you like to pursue in the future?

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* 13. ACCOMPLISHMENTS: What do you consider your highest responsibility, skill or career achievement to date?

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* 14. GOALS: What do you hope to gain through your participation in Leadership Cayuga?

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* 15. COMMUNITY: What do you think is the most significant challenge(s) facing Cayuga County?

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* 18. If accepted, nominee for Leadership Cayuga program must have the support of their employer because of the time commitment involved. I certify that my employer/sponsor is aware of my Leadership Cayuga application and supports my effort to be a part of this class.

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* 19. Please enter your supervisor's name and contact information.

* 7. EMPLOYMENT: (Employment is not a requirement for acceptance into the Leadership Cayuga program.)
Which of the following best describes your current employment/activity?

* 18. If accepted, nominee for Leadership Cayuga program must have the support of their employer because of the time commitment involved.

I certify that my employer/sponsor is aware of my Leadership Cayuga application and supports my effort to be a part of this class.