* indicates required
Online Leadership Application
PERSONAL DATA
First Name:
*
MI: Last
Name:
*
Business Name:
*
Business Address:
*
City:
*
State:
None
Alaska
Alabama
Arizona
Arkansas
Armed
Forces Americas
Armed
Forces (General)
Armed
Forces Pacific
California
Colorado
Connecticut
District
of Columbia
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*
Zip Code:
*
Business Phone:
*
(e.g. 999-999-9999)
Cell Phone:
(e.g. 999-999-9999)
Business Fax:
(e.g. 999-999-9999)
Email Address:
*
Name of President or CEO:
*
Current Position:
How long with company:
Home Address:
*
City:
*
State:
None
Alaska
Alabama
Arizona
Arkansas
Armed
Forces Americas
Armed
Forces (General)
Armed
Forces Pacific
California
Colorado
Connecticut
District
of Columbia
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*
Zip Code:
*
Home Phone:
*
(e.g. 999-999-9999)
Sponsoring Organization: (if
different from business)
Address:
City:
State:
None
Alaska
Alabama
Arizona
Arkansas
Armed
Forces Americas
Armed
Forces (General)
Armed
Forces Pacific
California
Colorado
Connecticut
District
of Columbia
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code:
Phone:
(e.g. 999-999-9999)
Name of President or CEO
EDUCATION & EXPERIENCE
State your educational and professional background including
degrees awarded, field(s) of study, professional experience,
institutes, training programs, etc. (You may email
us a resume to answer this question, just indicate so below.)
TUITION
Tuition for the Leadership Aurora program is $950 per participant. Tuition covers all program costs, meals,
and materials. A limited number of partial scholarships are available to those not otherwise able to pay the full
tuition. Scholarships are awarded based on need and class composition. Tuition is due in full by September
1st unless prior arrangements have been made.
Full tuition of $950 can be paid
I request scholarship assistance
(please explain how much is needed, why
and specific $ amount)
If requesting a scholarship, what portion of tuition can you pay?
REFERENCES
List two persons who have knowledge of your qualifications to be a Leadership Aurora participant.
1. Full Name & Title:
*
Phone:*
(e.g. 999-999-9999)
Business or Home Address:
*
City:
*
State:
None
Alaska
Alabama
Arizona
Arkansas
Armed
Forces Americas
Armed
Forces (General)
Armed
Forces Pacific
California
Colorado
Connecticut
District
of Columbia
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*
Zip Code:
*
2. Full Name & Title:
*
Phone:*
(e.g. 999-999-9999)
Business or Home Address:
*
City:
*
State:
None
Alaska
Alabama
Arizona
Arkansas
Armed
Forces Americas
Armed
Forces (General)
Armed
Forces Pacific
California
Colorado
Connecticut
District
of Columbia
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*
Zip Code:
*
EMPLOYER AUTHORIZATION
Please click on the below link to get a printable employer authorization form, this must be completed by your employer in order to complete your application.
* Click Here for Employer Authorization Form »
GOALS
Please identify and discuss a particular issue, opportunity, or problem you feel is
crucial to the Aurora area. (Be prepared to possibly discuss during your oral interview)
How would you expect to use your Leadership Aurora Experience?
What can you contribute to the program?
COMMUNITY INVOLVEMENT
Please list the civic activities that you have participated
in during the last five years. For each activity, indicate
the nature of your participation. If you have not been
involved in any civic activities, please explain why in
the box below.
(List organization or activity and then a description of involvement)
COMMITMENT
In order to accomplish Leadership Aurora's
objectives, the full commitment and participation of each
individual selected is necessary. Participants are expected
to attend all sessions including:
1) Two-Night Opening Retreat - scheduled
mid to late September (mandatory
attendance).
2) One full weekday each month on the third Thursday from
October to May 3) Graduation Program - 1/2 day session plus
luncheon in early June 4) Community experiences required
independent of class sessions.
If selected, I am fully prepared to be an active participant
and devote the time and energy required to complete the
Leadership Aurora program. I have read and understand
the
Cancellation & Refund Policy .
This is a
Legal Digital Signature by typing your name and the date
below you understand the requirements for participation
in the program and have read the Cancellation & Refund Policy
and completed this form to the best of your knowledge.
Full Name: * Date:
*
Please note: Application must be received
at the Aurora Chamber of Commerce by July 15th. All applicants
must participate in a personal interview with the Selection
Committee. Tuition is due on or by September 1st once you
have been selected.