INSTRUCTIONS FOR COMPLETING
On behalf of the Roswell Chamber of Commerce and the Leadership Roswell Program, we appreciate your interest in the Leadership Roswell Program. We believe that Roswell is the best community in the world in which to live.
Please type or print legibly using black ink. Please make an effort to limit your responses to the space available.
As the class is selected primarily based on the written application, it is important that you express yourself clearly and concisely in the written application. Because more applicants than class spots are available, it is not unusual for a candidate to apply the next year. Take time to complete the application fully using the answer space available. The deadline for this year is Monday, July 31st, at 5:00 pm.  
Please deliver or mail your application to the Roswell Chamber of Commerce, 131 W. Second St., Roswell, New Mexico, 88201, by the deadline included in the information brochure. If you have any questions, please call the Roswell Chamber of Commerce at 575-623-5695.
The selection committee will select the class in August, after which you will be contacted regarding your application.
Good luck, and again, thank you for your interest…
Rick Kraft, Executive Director

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* 1. Name

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* 2. Age

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* 3. Date of Birth

Date

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* 4. City/State of Birth

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* 5. Name of Spouse or Significant Other

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* 6. Home address

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* 7. Home Phone

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* 8. Work Phone

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* 9. Cell Phone

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* 10. E-mail

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* 11. Employer

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* 12. Business Address

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* 13. Supervisor's Name

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* 14. Have you previously applied for the Leadership Roswell Program? (Preference will be given to individuals who have previously applied)

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* 15. INSTRUCTIONS IF ACCEPTED

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* 16. Information as you would want it on your name badge or to be published or broadcast

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* 17. Name

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* 18. Title

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* 19. Employer

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* 20. Where do you want your mail sent?

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* 21. Who will be paying your tuition?

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* 22. Will your participation require a scholarship? (Limited availability based on financial need)

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* 23. If yes, please explain why.

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* 24. Personal References:
List between two and four personal references. Reference letters are not required but may be submitted along with the application:

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* 25. ABOUT YOUR BACKGROUND:

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* 26. The number of years lived in Chaves County since graduation from high school.

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* 27. How long do you anticipate at this time remaining in Chaves County?

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* 28. Education (include high school, college, business, or trade schools and/or specialized training, list in reverse chronological order)

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* 29. Did you receive any educational recognitions or honors?

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* 30. If yes, what?

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* 31. Non-school-related recognitions, honors, or distinctions (include year).

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* 32. ABOUT YOUR EMPLOYEMENT

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* 33. Length of service with the present business.

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* 34. Are you subject to transfer?

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* 35. Brief description of your job duties and responsibilities.

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* 36. Previous employment (in reverse chronological order).

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* 37. ABOUT YOUR COMMUNITY SERVICE:

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* 38. List all community, civic, professional, business, religious, social, academic, and other volunteer organizations of which you have been a member in order of their value to you.

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* 39. How much time per month is currently committed to community, civic, professional, and other organizations and activities?

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* 40. Have you been as active in civic activities as you would like to be?

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* 41. If no, what have been your major barriers to becoming involved?

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* 42. If you became interested in a particular organization or activity, how much time per month could you commit to helping the organization or activity be a success?

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* 43. ABOUT ROSWELL:

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* 44. What are the three greatest concerns that you see facing the Roswell community, and what recommendations do you have for improvement in these areas?

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* 45. What do you believe is the greatest strength of the Roswell Community?

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* 46. What do you see as your future role in the Roswell Community?

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* 47. ABOUT YOURSELF:

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* 48. What do you consider to be the highest responsibility or accomplishment of your life and why?

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* 49. What do you hope to gain from participating in the Leadership Roswell Program?

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* 50. ABOUT YOUR COMMITMENT:

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* 51. The cost of the program is $650. This amount is due before or on the first class date. A limited number of scholarships are available. Please get in touch with program director Rick Kraft at 575-625-2000.

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* 52. I have read the Leadership Roswell information brochure, and I understand the eligibility requirements and the commitment expected of me:

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* 53. I understand the eligibility requirements and fully support our employee’s commitment to be absent from our business on the nine Fridays of class days and the Monday/Tuesday trip to Santa Fe:

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* 54. Today's Date

Date

T