Name *

Employer *

Job Title *

Work Address *

City/State/ZIP *

Home Address *

City/State/ZIP *

Phone *

Email *

How did you hear about Leadership Kenosha? *

Enter required value Coworker/Colleague referral Other Kenosha News Kenosha.com Kenosha Area Chamber of Commerce Social Media Word of mouth

Please use my... *

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Mailing List Opt-in *

We occasionally receive requests for mailing lists. Please choose one:

Enter required value Yes, you may give out my name. No, do not give out my name.

Age

Gender

Ethnicity

Kenosha Area Needs *

One sign of an effective leader is the ability to identify needs and suggest possible solutions. With that in mind, briefly tell us about one or more needs that exist in the Kenosha area or in your work setting. In addition to identifying the need, provide one or more recommendations for addressing it.

What Do You Hope To Gain? *

What do you hope to gain from Leadership Kenosha? How do you believe you will apply the knowledge gained as a Leadership Kenosha participant?

What is your leadership priority? (choose any two) *

Aspiring leader

Building on my current role or skills

Career advancement

Community involvement and awareness

Equity, Diversity and Inclusion

Employee retention

Networking

Professional development

Community Involvement *

Please describe ways you have been involved in community service (include adult involvement in Kenosha and/or other communities).

Work History *

Please describe positions you have held in the past five years, and any other workplace leadership opportunities you have held (task force member, committee chair, etc.).

Name *

Address *

City/State/ZIP *

Phone *

Optional: attach resume

20MB max

The Fine Print *

Attendance

Enrollment in Leadership Kenosha provides participants an opportunity to enhance their leadership skills while exploring a broad array of community and workplace issues, topics and settings. Attendance at these sessions and exposure to this information are the building blocks of the Leadership Kenosha program. It is for this reason that Leadership Kenosha has instituted an attendance policy allowing for limited excused absence. Attendance at the September Retreat is mandatory. In addition to the Retreat and Graduation, the time commitment is 8 sessions (October–May). Participants should confirm with their supervisor their ability to gain release time from work responsibilities in order to attend each session. If a participant misses more than the equivalent of two sessions, their eligibility for graduation will be reviewed. 

Experiential Projects

The small group project allows Leadership Kenosha participants to put their skills to work in a non-profit, business, or community setting. While some of this project work will be completed during regular program sessions, it is expected that some project work will take place outside of scheduled sessions. The amount of time you will need to devote to the development of your project will be determined by consensus of your Leadership Kenosha team.

Tuition 

The tuition fee is $1,500. Tuition for Kenosha Area Chamber of Commerce Members is $1,300. For 501(c)3 non-profit organizations it is $1,200. You do not need to submit the fee at this time, an invoice will be sent. Credit cards can be accepted. Partial refunds and/or credits are available prior to December 31st. There are no refunds or credits available after December 31st. 

Scholarships

Scholarships are available for candidates who demonstrate a clear need for such assistance. If you wish to apply for a scholarship, send an email to info@kenoshaareachamber.com explaining the reason for and specific dollar amount of your request.

• Full scholarships are not available. 
• Each participant is expected to contribute a minimum of $500 toward their tuition. 
• Individuals who request scholarships should indicate whether they are being sponsored by their employer.
• Only those requests received by June 15 will be considered for scholarships.

Upon request, policies regarding tuition, reimbursements, credits, and scholarships are available for review.

Participant Agreement

If selected as a Leadership Kenosha participant, I understand that I am making a commitment to the future of the Kenosha community. Along with this commitment comes unlimited opportunity for involvement in workplace, civic, political, social and other activities of my choosing. I accept this invitation and the opportunity it may bring.

By typing my full name below as a signature, I agree to the above.