2024-2025 L.E.A.D. Independence Application

A leadership development program of the Independence Chamber of Commerce.
Deadline for submitting applications is September 1st, 2024.
The cost of this program is $600
Thank you for your interest in LEAD Independence.

First Name *

Last Name *

Employer *

Title/Position *

Employer Address

Address Line 1 *

Address Line 2

City *

Zip/Postal Code *

Business Phone *

Business Email *

Cell Phone *

Supervisor's Name *

Supervisor's Phone *

Supervisor's Email *

Do you have any food allergies? *

Why are you interested in joining the LEAD Independence class? *

We meet 8:45am-5pm the 3rd Thursday each month September-May. It is IMPERATIVE to the program that each participant attends all days for the FULL day. How will you arrange your work to be able to attend each day? *

What do you hope to gain from your involvement in LEAD Independence? *

A limited number of partial scholarship opportunities are available for those who would otherwise be unable to participate in LEAD Independence. Are you interested in being considered for a scholarship?

Yes No

If you clicked yes above, please give an explanation of your need.

Location

Phone

Hours

Location

Phone

Hours

2024-2025 L.E.A.D. Independence Application