Leadership Cortland Application 2024-2025

Leadership Cortland Application 2024-2025

Sponsored by The Cortland Area Chamber of Commerce

Confidential Application

Leadership Cortland is designed to identify, educate, and motivate a select group of Cortland area citizens for positions
of community leadership. Participants are selected based on ability, leadership potential, interest in the community, and willingness to commit the time and energy to complete the program. They must have the full support of the corporation or organization represented.
Personal

First Name *

Last Name *

Preferred First Name

Middle Name

Home Address

Address Line 1 *

Address Line 2

City *

State *

Zip/Postal Code *

Home Phone
with area code.

E-mail Address (Personal- in case of change in job) *

Length of residency in The Cortland area

Work

Employer *

Employer Address

Address Line 1

Address Line 2

City

State

Zip/Postal Code

Employer’s Phone *
with area code.

E-mail Address (Work) *

Application for (year) *

Fall 2024-2025 Fall 2025-2026

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Education

(begin with high school, then college(s), business or trade schools and/or specialized training)

Name of School *

Dates
(from - to)

Degree

Major

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Name of School

Dates
(from - to)

Degree

Major

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Name of School

Dates
(from - to)

Degree

Major

Special Awards, Honors, Extracurricular Activities

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Employment

Present Employer *

Date Began

Supervisors Name *

Supervisors Email *
We will need to confirm their approval.

Present Title or Responsibility *

Received Current Title Or Responsibility
Year

What do you consider your highest responsibility, skill, or career achievement to date?

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Activity Data

Describe activities and organization involvement

Why do you want to participate in Leadership Cortland, and what qualities do you feel you can bring to the success of the program?

Signature *

By checking this box you are signing this form as the applicant.

Supervisor Approval *

I acknowledge that I have received approval from the head of the sponsoring organization and/or my supervisor.

Nominations for the Leadership Cortland program must have support and commitment from their sponsoring business or organization because of the time involved. Please make sure you have provided their correct email so we can contact them.

Tuition $ 850.00

You will be emailed an invoice. If paying by check, please make check payable to The Cortland Area Chamber
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