Leadership Fargo Moorhead Application

Application Instructions

  1. Once you begin the online application process you are required to complete it. You may want to view the application questions to prepare your answers prior to beginning the process.
     
  2. Two letters of reference are required following your online application submission. The reference form may be downloaded at the end of your application, completed and e-mailed to ashley@fmchamber.com.  One letter is to come from your supervisor, (or if you are self-employed, someone from the community) the other from a colleague or service organization in which you are involved.
     
  3. Completed online application and e-mailed letters of recommendation are due by
    May 21, 2010.
     

Leadership Fargo Moorhead Application Form


Personal Data
*Full Name
*Preferred Name
*Employer
Job Title
*Business Address
*Business Phone
 - -
Cell Phone
 - -
*Business Fax
 - -
*E-mail Address
*Supervisor
*Supervisor's E-mail Address
*Years with Employer
Demographic Profile
Leadership Fargo Moorhead seeks to reflect the diversity of the community in its class. The following questions may be answered at the discretion of the applicant.
*Gender
Male      Female
*Ethnic Origin
Africa American
Asian American
Caucasian
Hispanic
Native American
Other
*Year of Birth
*Years in the F-M Region
*Highest Level of Education
 High School
Some College
Business/Trade School
4-year Degree
Masters
PhD
Other
Have you ever applied to LFM before? Yes     No
* Employment Profile
(Check all that apply)
Arts/Entertainment
Associations/Clubs
Business (large) Business (small)
Construction Education
Financial/Real Estate/Insurance Government
Healthcare Legal
Manufacturing Media
Non Profit Retail
Religious Organization Social Service
Telecommunications  
Other
Leadership and Community
(Please ensure that your response addresses the question or topic.)
*How did you learn about Leadership Fargo Moorhead?
*List professional and non professional activities/organizations you have participated in during the past five years?
*Describe how you contribute to the success of your business/organization.
*What one community issue interests you? What strategic initiatives do you feel are critical to the solution? How do you hope to become involved?
*Why would you like to be selected for LFM, and how would you contribute to the class?
*Personal interviews will take place June 15, 16, and 17. If I am selected, the following is my preference. 1st preference  
2nd preference 
3rd preference  
Please check the following boxes to show your agreement with the program.
* Employee and Employer agree to make both the time and financial dedication Yes, I agree.
* Please indicate your request for financial assistance. Partial Scholarship
Extended Payment Plan
* I am aware of the attendance policy and additional time requirements and I agree to participate fully. Yes, I agree.