1. CONFIDENTIAL APPLICATION - DUE FRIDAY, JULY 26, 2024

  2. *First and Last Name:
  4. *Cell Number:
  6. *Personal Address:
  8. *Personal Email Address:
  10. *Emergency Contact (Name and Phone Number)
  12. *Employer/Organization:
  14. *Job Title:
  16. *Work Email Address:
  18. *Work Address:
  20. *Sponsored By: (Organization Name)
  22. *Select Sponsor Type:
  24. *Sponsor Name:
  26. *Sponsor Phone Number:
  28. *Sponsor Email:
  30. *How many years have you lived in Pitt County?
  32. *Please list three civic, professional, business, religious, social, athletic, and other organizations of which you are or have been a member in the last three years? (Please separate your answers with a comma)
  34. *Please include any achievements you have received in the last three years. (Please separate your answers with a comma)
  36. *What does Leadership mean to you?
  38. *What are 2-3 goals you'd like to get out of participating in Leadership Institute? (Please separate your answers with a comma)
  40. *What do you view as your strengths and in what areas do you believe you could improve?
  42. *What do you feel are the most significant challenges facing Greenville-Pitt County?
  44. No more than two (2) days can be missed in order to graduate. Arriving late or leaving early will be counted as a half-day’s absence. If a participant is unable to attend a session, he/she is expected to notify the Chamber’s staff coordinator at least 24-hours in advance of the scheduled session. Failure to adhere to the enforced policy will result in a participant not being able to graduate from the program.

  45. *Submission of this application confirms you and your employer have read and understand the attendance policy as stated here and, in submitting this application, agree to be bound by such.

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