Leadership Cape Application

 
 
 

Applicant Information

 

First name 

 

Last name 

 

Business name 

 

Position/title 

 

Time spent in current position 

 

Business address

 

Business phone 

 

Email 

 

Cell number 

 

Cell carrier (to receive pertinent text alerts) 

 

School/University 

 

Degree 

 

Major 

 

Advanced or professional training 

 
 
 
 
 

Involvement

 

Please list all business/professional organizations you are involved with: 

 

Please list all community/civic organizations you are involved with: 

 

Have you participated in a similar leadership program in another community? 

 
 
 
 
 

Please tell us...

 

In your opinion, what are the three (3) most critical problems/issues facing Cape Girardeau today? 

 

Please provide a brief statement of the reason(s) you wish to participate in Leadership Cape: 

 

What do you expect to gain from participating in Leadership Cape? 

 
 
 
 
 

References

 

Please provide two (2) professional references other than your current employer.

 

Name 

 

Company 

 

Phone 

 
 

Name 

 

Company 

 

Phone 

 
 
 
 
 

Tuition

 

If accepted into the Leadership Cape Girardeau program, you or your firm will be billed for the tuition fee of $595 for Cape Chamber members or $645 for non-Cape Chamber members. Tuition covers supplies, meals, transportation, etc. during the sessions. Tuition must be paid in full by March 1, 2019 and is non-refundable.

 

My tuition will be paid: 

 
 
 
 
 

Applicant agreement

 

By submitting this form,

 

• I understand attendance at the class retreat (March 15, 2019) is mandatory and if I miss the retreat, I will no longer be a member of the 2019 Class.

 

• If selected as a participant in Leadership Cape, I am willing to attend all functions sponsored by the program, and I understand attendance is mandatory.

 

• I understand I am to notify Kim Voelker or Dana Brune when I am unable to attend a session.

 

• I understand if I miss more than one session, I will need to make up the session(s) the following year in order to graduate.

 

• I understand I will be required to complete a team project which will require an additional time commitment above and beyond regularly scheduled sessions. Participation is mandatory.

 

• I understand, as a leader, I represent my organization and will conduct myself at all times in a professional manner.

 

• I understand if I fail to meet any obligations of the program, I may be asked to withdraw or may not graduate with my class.

 
 
 

I have my employer's approval to participate in Leadership Cape. 

 
 

Supervisor's name 

 

Supervisor's email 

 
 
 

Applicant's e-signature 

 
 
 
 
 

This completed application must be received by 5:00 p.m. on February 1, 2019 to be considered.

 

Expect a notification of acceptance by February 15, 2019.

 

Questions? Call (573) 335-3312, email Kim Voelker or Dana Brune.