Leadership Natchitoches Application 2023

Name

First Name *

Last Name *

Preferred email, to be used for all Leadership Natchitoches communications. *

Preferred phone number, to be used for all Leadership Natchitoches communications. *

Name as you want it to display on your name badge *

Company/Organization/Agency *

Title *

Office Address

Address Line 1 *

Address Line 2

City *

Zip/Postal Code *

Home Address

Address Line 1 *

Address Line 2

City *

Zip/Postal Code *

How long have you lived in Natchitoches parish? *

Age *

How did you hear about this program? Please select all that apply. *

Social media Email My employer A Chamber event A non-Chamber event The Chamber website Other

If other, please specify.

Check the box below only if this statement applies to you.

I am unable to afford tuition but I am interested in scholarship opportunities, if available.

High resolution picture *

A letter of support from your employer. *

A letter of recommendation. *

Brief resume or bio that includes the following: -Education & Training—College, Specialized Training, Dates Attended, Certificates or Degrees -Employment—Present Employer (title, date began, brief description of responsibilities), Brief History -Elective Offices, Awards, Honors, Recognitions *

Answer the following questions and upload one file containing your answers: 1) Please list your civic, political, social, professional, religious or other activities. (Organization, Position Held and Dates). 2) What do you consider your most significant contribution, role or achievement in your professional career? 3) What do you consider your most important (non-employment related) leadership, civic, or service contribution or role? 4) Describe what you hope to gain from your Leadership Natchitoches experience. 5) Please share your opinion of the most significant challenge facing the Natchitoches Area in the next 5 years. (This answer will be printed in the Class Directory for the Opening Retreat). *

Read the Policies and Procedures document linked above. *

By checking this box I hereby agree to the Natchitoches Area Policies and Procedures for Leadership Natchitoches

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