Personal InformationFull Name *Email Address *Phone Number *Business InformationCurrent Employer *Job Title *Business Number *ResponsibilitiesStreet AddressApartment, suite, etcCityState/ProvinceZIP / Postal CodeList of Three References (personal or business)1. Reference Full Name *Email *Phone Number *2. Reference Full Name *Email *Phone Number *3. Reference Full Name *Email *Phone Number *Community Engagement Please list some organizations of which you are or were a member. You may wish to include civic, professional, business, religious, social, athletic or other organizations. Please use an additional sheet, if necessary!List Organization & Role HereYour ViewsWhat social, economic, and/or community issues are you interested in?ClimateEmploymentSocial ServicesArtsEducationPoliticsAddiction IssuesMental HealthVolunteerismHousingTransportationGeneral InfrastructureSmall BusinessesLeadershipWorkforce DevelopmentCommunity DevelopmentSustainable DevelopmentOtherLeadership Monadnock has 9 monthly class sessions which will be held on the second Wednesday of each month, beginning in October 2023 and ending in June 2024, from 8:30 AM – 4:00 PM. We will also hold a graduation in June after the last class that will invite previous Alumni of Leadership Monadnock for networking and celebration. June 20th 2024 Please Read Before Signing: Program candidates: Leadership Monadnock brings together individuals with a wide range of backgrounds and experiences who have a strong interest in community leadership. Application procedure and deadline: Please email your completed application to Luca@greatermonadnock.com or submit on here or to Leadership Monadnock, 48 Central Square, Keene, N.H. 03431. The application deadline is September 15, 2023 Total cost and scholarships: The total cost of the program is $995 for members of the Greater Monadnock Collaborative or $1500 for non-members. We will bill you once you have been accepted into the program. Financial aid may be available for a limited number of individuals, if you are interested in learning more about financial assistance, please check the box belowI am interested in learning more about a scholarshipSelection process: All applications are reviewed by the Selection Committee. Notification of selection status will be communicated shortly after the application deadline. As program costs are incurred in advance, tuition fees will only be refunded on a prorated basis. Thank you for applying to the Leadership Monadnock program, we will contact you after the application deadline with any next steps. For more information, please email Luca@greatermonadnock.com or call the Greater Monadnock Collaborative at 603-352-1303. Your signature below indicates you have read and understand the information listed above.Applicant Signature *Date *Employer Acknowledgment I understand that this program requires 9 in-person meetings, once per month from 8:30 AM-4:00 PM from October 2023 to June 2024.Employer Signature *Date * Send Message
