Leadership Twin Cities Sample Application

This is the information you will need in order to complete the Leadership Twin Cities application. This is not an actual application. To complete the online application, please visit www.minneapolischamber.org/leadership and select the link to access the online application.

Contact Information Prefix First Name Last Name Email Phone (ie: 612-370-9100) Title Company Information Company Name Business Address City State Zip Code Supervisor's Name Supervisor's Title Supervisor's Phone (ie: 612-370-9100) Supervisor's Email Organization Type

Non-Profit

Public Sector/Government

Organization Size (Based on Full Time Employees)

0-10

11-74

75-250

251 +

Application Questions

Please answer the following five questions using the text areas provided. The boxes will expand to allow for longer responses if needed. 1. What do you do? Please tell us about your current job responsibilities and share a brief summary of past positions.

2. Please tell us about your educational background.

3. List up to three organizations (professional affiliations, civic, religious, athletic or social organizations) with which you are currently involved or have been involved with in recent years.

• List them in order of importance to you • Designate if you are still actively involved and if any official offices held. • If you are not currently involved with community activities, please describe past experiences and

where you might see yourself involved in the future.

4. Identify and discuss an issue that you feel is critical to the Minneapolis-Saint Paul region.

5. Why are you seeking admission to the Leadership Twin Cities program? What do you hope to gain from your experience?

Supervisor Support

It is important that Leadership Twin Cities participants have the support of their supervisor and employer. Some corporations have an internal process for selecting applicants from their organization. Applicants are encouraged to discuss the application process, program cost and time commitment with their employer prior to submitting an application. Have you discussed your application with your supervisor?

Yes

No If no, please explain. Have you previously applied for the Leadership Twin Cities program?

Yes

No If yes, when? How did you learn about Leadership Twin Cities?

Chamber email or newsletter

Chamber website

Social Media Post (Facebook/Linked In/Twitter)

Referred by a past or current participant

Referred by my supervisor or company representative

Other Name of person who referred you

If other, please explain.

Personal Information

The following information is optional but very helpful. The selection committee works to assemble a participant group that represents a cross-section of the community. Factors that may affect the final class selection include age, ethnicity, gender, geographic location, vocation, life experiences and industry sector. The information in this section is confidential and will not be made public. Home Address City State Zipcode Gender

Female

Male Ethnic Background

Caucasian Hispanic

African American Asian

American Indian Other

Age

Under 25 25-34

35-44 45-54

55-64 Over 65

Highest Level of Education

High school diploma or equivalent

Attended college and/or associates degree

College graduate

Masters program graduate

Ph.D. or professional degree