Leadership Wilmington Class of 2021 Application

Leadership Wilmington Class of 2021 Application

Application to participate in the 2021 Class of Leadership Wilmington.
Personal Information

Name

First Name *

Last Name *

Home Address

Address Line 1 *

Address Line 2

City *

State *

Zip/Postal Code *

Work Address

Address Line 1 *

Address Line 2

City *

State *

Zip/Postal Code *

Cell Phone: *

Email (where you would like program info sent): *

Length of Residence in Greater Wilmington Area: *

Gender: *

Race: *

Date of Birth *
Format: M/d/yyyy

Place of Birth *

Have you ever participated in another state or community leadership program? *

If yes, name of program(s) and location: *

Do you require any special accommodations or have food allergies or dietary restrictions of which we should be aware? Describe: *

Describe your interest in Leadership Wilmington *

Education

Name/Location of High School *

Years To-From *

Degree *

Major *

Name/Location of College *

Years To-From *

Degree *

Major *

Name/Location of Graduate *

Years To-From *

Degree *

Major *

Employment

Current Employer *

Month/Year of Hire with Current Employer *

Supervisor Approving Your Participation in Leadership Wilmington

First Name *

Last Name *

Their Position in The Company *

Business Mailing Address

Address Line 1 *

Address Line 2

City *

State *

Zip/Postal Code *

Business Telephone *

Type of Organization/Business *

What is your job title and what are the responsibilities of your employment? *

What do you consider your most significant career achievement to date? *

Business and Professional Affiliations

Do not include civic organizations and political activities.

Name of Group, Position/Assignments, From - To *

Name of Group, Position/Assignments, From - To *

Name of Group, Position/Assignments, From - To *

Community Involvement

List community, civic, religious, political, government, social, athletic, or other activities. Do not include business and professional activities. Other community activities may be listed as an addendum to this application, if you wish.

Name of Organization, Position/Assignments, From - To *

Name of Organization, Position/Assignments, From - To *

Name of Organization, Position/Assignments, From - To *

What do you consider your most important accomplishment to date in the Wilmington community? *

General Information

This information will be used to plan sessions.

Describe what you believe to be the three most significant challenges facing the Greater Wilmington area. *

Describe what you believe to be the three most notable opportunities for the Greater Wilmington area. *

What skills and knowledge do you hope to gain from participating in Leadership Wilmington? *

Please describe your expectations about content, discussions, and speakers for each Leadership Wilmington session.

This information may be used in planning the 2021 sessions.

Arts, History, and Culture *

Environment *

Education *

Human Services *

Infrastructure *

Crime and Punishment *

Growth and Development *

Politics and Government *

Biographical Sketch

Please attach a half-page biographical sketch and a headshot. If you are named a member of Leadership Wilmington 2021, this information will be included in the Leadership Wilmington participant notebook and will be distributed to class speakers.

Upload Headshot *

Upload Half-Page Biographical Sketch *

Tuition

The cost of participation in Leadership Wilmington is $2,000. This amount covers all program costs including meals, materials, retreats, and graduation exercises. Tuition must be paid prior to the beginning of the program.

Please send tuition invoice to: *

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