Leadership Oshkosh Application

First Name

Last Name

Employer

Job Title

Billing Address

Billing City

Billing State (abv)

Billing Zip Code

Mailing Address (if different from Billing Address)

Mailing City

Mailing State

Mailing Zip Code

Mailing Address is…

Home

Employer

Other

Phone

Years in the Oshkosh Area

Any dietary restrictions?

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

Special honors/awards for leadership/academic performance

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

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

References (name, title, organization, city)

Why do you wish to participate in Leadership Oshkosh?

What types of community leadership activites would you like to become active in after you complete the Leadership Oshkosh program?

If you are human, leave this field blank.