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Leadership Troy Program Application | 2023

Leadership Troy 
Program Application




Application directions:
Apply online before December 1. Be sure to complete all questions. If you need a paper copy of the application, please contact the Chamber office at 937-339-8769.

Please verify that you have checked the “I'm not a robot” checkbox.

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🔸 PERSONAL INFORMATION 🔸

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🔸 EMPLOYMENT INFORMATION 🔸

Absenteeism will result in being dropped from the course. If you are unable to make a commitment, it is not in your best interest to apply at this time. Please type your initials in the box below to indicate you understand the importance of attendance.

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🔸 EDUCATION / TRADE 🔸

Begin with high school, then college(s), business or trade school and/or specialized training.
School / Dates/ Degree/ Major

School Dates Degree Major Comments

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🔸 ORGANIZATIONS & ACTIVITIES 🔸

Please list community, civic, professional, business, religious, social, athletic, and other organizations of which you are currently involved or a member.

Organization Name Date of Membership Official Position(s) held Other

Yes
No

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🔸 GENERAL INFORMATION 🔸

Poor
Fair
Good
Excellent

Poor
Fair
Good
Excellent

Yes
No

Work Day = extended lunch or breakfast, leaving early to attend an early evening meeting. 

Yes
No

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🔸 ESSAY QUESTIONS 🔸
Please complete the following essay questions. Please note that these questions play an important role in the decision process when forming the LT class.

Please share your reasons.

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🔸 EXTERNAL REQUIREMENTS 🔸
Included as part of the Leadership Troy Program experience is the requirement to complete the following experiences:

If chosen to be a participant in Leadership Troy, you will be given to an opportunity to pick your first, second and third internship choices from a supplied list of available non-profit boards. You will be given dates and times of regular board meetings so your selection can appropriately fit your schedule.  NOTE: This is subject to having enough participating non profits.  

I understand.

If chosen to be a participant in Leadership Troy , you will be teamed with other participants in a small group to work and complete a project which will benefit a local non-profit or the community. Some time will be given during the monthly sessions, but this will require additional time outside of the program.

I understand.

If chosen to be a participant in Leadership Troy , you will be required to read a leadership book provided by the program for the purpose of discussing and exploring how to lead. The book will be provided at the beginning of January and MUST be completed by the February session.

I understand.

I understand.

Myself
My employer (contact information required)
Third Party (contact information required)

Billing Contact Name Billing Contact Organization Billing Contact Email Billing Contact Phone Other
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