Leadership Oshkosh Application

Personal Information

First Name *

Preferred Name

Last Name *

Employer *

Billing Address *

Billing Address

City

State/Province

Zip/Postal

Mailing Address (if different from billing address)

City

State/Province

Zip/Postal

Mailing Address is:

Employer

Home

Other (specify)Other (specify)

Preferred Phone Number *

Email Address *

Years in the Oshkosh Area *

Which do you represent? *

Business

Individual

Organization

Any dietary restrictions? *

Education

Name/Location of School, Dates (From-to), Degree, Major *

Special awards, honors or prizes for academic performance: *

Extracurricular activities/hobbies: *

Special honors/awards for leadership activities: *

Employment

Job Title *

Start date with present employer (mm/dd/yyyy): *

How many days per month does your work require you to be out of the city? *

Do you have employer support for the time required to participate in Leadership Oshkosh? *

Previous employer(s) (List last positions first, include military duty): *

Briefly describe your present job responsibility or activities: *

Community Involvement

List business, professional affiliations, civic, community, religious, political, social, athletic or other activities: *

Reference

Name *

Title *

Firm/Organization *

Phone Number *

City *

Applicant's Personal Statement

Why do you wish to participate in Leadership Oshkosh? *

What do you hope to get out of your experience in this program? *

What types of community leadership activities would you like to become active with after you complete the Leadership Oshkosh program? *

What do you consider your one most important achievement to date? *

Captcha

PARTICIPANT COMMITMENT

To graduate from Leadership Oshkosh, a participant is required to attend:

Orientation Retreat: A two-day, out-of-town overnight session in September
One full weekday each month – October through May
Evening graduation in May
Non-profit, adjunct board meetings
Participation in fundraising event

EMPLOYER COMMITMENT (if applicable)

This application has the approval of this organization, and the applicant has our full support, which includes the time required to participate in the program.

For more information

Contact Trina Woldt via: [email protected] or at (920)303-2265, ext. 29.

This program has a limited number of participants. If you are not selected for the current class, you are encouraged to apply again in a subsequent year.

PURPOSE

Leadership Oshkosh engages leaders through community involvement that promotes a thriving community built on enhanced community knowledge and motivated by improved leadership skills.