2024 Application for Leadership Chatuge Class 7

1. Preferred email address. *

2. First and Last Name. *

Name that you would like on your certificate at completion.

3. Preferred mailing address. *

3. Preferred mailing address.

City

State/Province

Zip/Postal

4. Telephone number

This is the number you don't mind others calling you on.

5. Name you would like on your name tag. *

Name you preferred to be called by.

6. Number of years you have been in the region. *

Text only - Example: five

7. County where you live. *

Clay

Cherokee

Towns

OtherOther

8. County where you work. *

Clay

Cherokee

Towns

OtherOther

9. Name of Employer. *

10. Name of supervisor. *

11. Your title or position. *

12. Company mailing address. *

12. Company mailing address.

City

State/Province

Zip/Postal

13. List up to 5 activities and/or organizations in which you invest your time and explain why they are important to you. *

14. List at least three issues that should be a priority for your community. *

15. Focusing on any one of the above, what would you recommend as a solution? *

16. Use the dropdown list to select your level of education.

17. What are you expectations of Leadership Chatuge? *

18. There are a multitude of ways to invest your new skill set in your community. In what ways might you be interested? Place a check by those of interest. *

Who will be paying the tuition?

Self

Company

Use the dropdown menu to select your level of tuition.

Total

I would like to be considered for a partial scholarship

Yes

No

Please provide details of why you should be considered for a scholarship. Note: tuition amount will not be available until after your application is reviewed.

23. For a participant to successfully complete Leadership Chatuge, the participant is expected to attend ALL sessions. Even though emergencies arise, any participant missing more than one session, for whatever reason, may be asked to withdraw from the program and no portion of the tuition will be refunded. Because of the this time commitment, it is important that an applicant have the full support of his/her employer to attend all sessions. I understand that purposes of Leadership Chatuge and if I am selected, I will devote the time (as set forth in the preceding paragraph) and resources necessary to complete the program. If you accepted these terms, please sign your name below.

Clear

You do not need to have a PayPal account to pay on line. After you click on the "Pay with PayPal' button you will be redirected to the PayPal site. Once you are on the PayPal site, select the option of "Pay with Debit or Credit Card" to pay and complete your registration.

If you are a Hinton employee, high school student or seeking a partial scholarship, by clicking the Pay with PayPal button, your application will be send directly to Hinton Center. Payment will be determined at a later time.

2024 Application for Leadership Chatuge Class 7

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