First Name *

Last Name *

Preferred Name

Organization *

Job Title *

Years with Current Employer *

Phone *

Address Line 1 *

Address Line 2

City *

State *

Enter required value

Postal Code *

Email *

Briefly describe your current employment responsibilities *

Outline your academic, training, and/or continuing education experiences *

Community, civic, professional, religious, social, and/ or other organizations *

List community, civic, professional, religious, social, and/ or other organizations of which you are, or have been, a member

Why do you want to participate in the Quincy Area Chamber of Commerce Leadership Institute? *

Letters of Recommendation

Two letters of recommendation are required with your application. Letters of recommendation should speak to your leadership qualities, personal/professional engagement with issues of importance to the community, how you will benefit from the program, and how the program can help you contribute to the Quincy area.

Letters should be addressed to the Quincy Area Chamber of Commerce Leadership Institute Selection Committee and sent via email to executive@quincychamber.org.

20MB max

Reference #1 *

Name & Email 

Reference #2 *

Name & Email 

APPLICANT COMMITMENT STATEMENT *

Please Save & Print the Applicant Commitment Form, Sign & Date, and Upload the form below.

20MB max