Springfield Leadership Workshop Application

Please complete the following application to be considered for the October Springfield Leadership Workshop.

Application Deadline

Extended to: Friday, September 29, 2017

Workshop Dates:

12:00pm - 5:00 pm; Tue. October 3, 2017 @ SUB Board Room; Wed. October 4, 2017 @ City Hall; Thurs. October 5, 2017 @ SUB Board Room

Fees:

$95 if you apply before 09/08/2017 - $125 after 09/08/2017

First Name

Last Name

Address Line 1 *

Address Line 2

City *

Zip/Postal Code *

Email:

Home Phone:

Cell Phone:

Work Phone:

Business Name (if applicable)

Occupation or areas of expertise:

Why are you interested in attending the Springfield Leadership Workshop?

Please describe any leadership, civic engagement, or volunteer experience you already have:

Please list the names and phone numbers of a minimum of two references that could speak to your participation in this leadership workshop.

I need a scholarship:

Yes No

By submitting this application, I commit to attending all workshop sessions *

Yes

Date and Time

Format: MM/dd/yyyy