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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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* 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. 

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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.

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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.

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