Leadership Perry 2024 Participant Form

Name

Title

First Name *

Last Name *

Suffix

Phone *

Email Address *

Home Address

Address Line 1 *

Address Line 2

City *

Zip/Postal Code *

Employer *

Employer Address

Address Line 1 *

Address Line 2

City *

Zip/Postal Code *

Title/Position *

Number of Years in Position *

Which of the following best describes your present position? Please check all that apply *

Business Education (primary, secondary, higher) Government Industry Non-Profit Professional Religion Social Service Volunteer

Major Job Responsibilites *

What do you consider to be your highest career achievement so far?

EDUCATION (Begin with high school, college, advanced degrees and/or specialized trainings.)

Please explain in detail three civic, business, religious, political, or social activities that you have participated in within the past three years in the Perry area. Please indicate the name of the organization, your assignment or position, and briefly describe your responsibilities

How much time do you commit each month to community, civic, professional, and/or other organizations and activities?

What do you consider to have been a highlight or accomplishment associated with any of the groups/activities mentioned above?

If you are selected to participate in the Perry Leadership (PL) class, what are your goals for involvement in the community?

List your strongest leadership characteristics. How can you benefit from further leadership training and development? *

What do you expect to gain from your participation in Perry Leadership? *

What are the three most pressing issues facing Perry and Houston County and why? *

What is or can be your role in addressing these issues? Please be specific: *

Describe how you plan to apply your enhanced skills and knowledge to benefit Perry and Houston County. *

Leadership Perry 2024 Participant Form

Perry Area Chamber of Commerce