Dear Employer,

Please note the program and tuition requirements in this packet and discuss these requirements with your employee to minimize schedule conflicts and maximize their opportunities in the program. If you have any questions, please contact Kayla Rombalski at talent@portagecountybiz.com or 715-344-1940.
Thank you for supporting Leadership Portage County!
 

Contact Details

Question Title

* 1. Contact Details

Why was this employee selected to participate in the LPC program?

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* 2. Why was this employee selected to participate in the LPC program?

As an employer, what are your short and long-term expectations of sending your employee to LPC?

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* 3. As an employer, what are your short and long-term expectations of sending your employee to LPC?

Consent

I understand the purpose of the Leadership Portage County program and that attendance, participation and a willingness to experience new activities is key to successful completion. If the applicant named above becomes a participant, I will let them devote the time and resources necessary to complete all components of the program. If for any reason the applicant named above does not complete the program, I realize that any scholarship funds they have received will have to be repaid.
I understand the above commitments and agree to be bound by them in signing this application. 

Question Title

* 4. I understand the above commitments and agree to be bound by them in signing this application. 

Date of Consent Given

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* 5. Date of Consent Given

Date / Time

T