Enrollment Guide & Application

Leadership Excellence Program Leadership Excellence improves your ability to manage change, create synergistic teams and uncover positive solutions. Leadership Excellence is a means to success, achievement and reaching your goals. It is an interactive leadership program designed to develop your professional and personal self, based on your strengths.

About the Program Leadership Excellence brings you:

• Discovery of needs and issues that demand leadership. • Exploration of leadership as a distinction from management.• Ideas on how to implement skills learned within your organization. • Understanding and appreciation of the connectedness with the community.• Illustrations of effective communications that command respect. • Ideas on how to navigate situations while maintaining focus on the ultimate goal. • Understanding of yourself in terms of strengths and weaknesses. • How to identify triggers that have caused missteps and how to make successful changes. • Lifelong learning through discipline and practice.• Introduction to network of leadership participants – current and past. • A high return on your investment as an owner or business leader.

The Right Participant The right participant:

• Can demonstrate a sincere commitment, motivation and interest to invest further in their community. • Has the ability, inclination and motivation to stretch, learn, achieve and contribute through significant career, personal and/or civic

accomplishments.• Has the willingness to commit to active and full participation in the program. • Has a desire for positive change.

The Commitment Program participants are expected to attend all full-day monthly sessions in their entirety, including the small group discussions and graduation dinner. The first five sessions must be completed in order to progress to the final sessions. A tentative listing of session dates and descriptions is available at www.wausauchamber.com in the overview and outline of the Leadership program section.

The Enrollment Process Applications will be reviewed and applicant will be contacted by the WRCC to schedule a one-on-one interview with the program administrator. The program administrator will assure geographic, minority, gender, industry diversity and community experience amongst the class(es). As part of the enrollment process, all applicants will be required to take a Myers-Briggs Type Indicator (MBTI) assessment. Applicants will be notified of their enrollment status. Program capacity is limited.

The Investment A $25 non-refundable application fee is due upon application. If an employer/sponsor prefers to issue one single payment for the application fee and tuition, it should be indicated in the Employer Acknowledgment & Agreement section of the application. Applicants not associated with a business cannot be billed. Once an applicant participates in the one-on-one meeting, the employer/sponsor is obligated to pay 50 percent of the total tuition fee by the due date listed on the application. Once accepted into the Leadership Excellence program, participant’s employer/sponsor will be billed for the tuition ($2,650 for WRCC members or $2,950 for non-members). Tuition covers all program costs, including room and speaker fees, break snack items and materials.

Scholarships for a portion of the tuition may be available as funds permit and are intended for non-profit or small businesses who may not have resources for the full tuition. Applicants interested in applying for a scholarship must indicate their intentions in the “…” section of the application. Upon acceptance into the program, participant will be notified of any scholarship award and the revised amount due.

If you have questions regarding participation, please contact Kim Smerda, Programs Director at 715.848.5942 or ksmerda@wausauchamber.com.

200 Washington St Ste 120 | Wausau, WI 54403 www.wausauchamber.com 715.845.6231

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Leadership Excellence Application

Application Year: ____________________________ (Deadline: May 15) Today’s Date: ____________________________

Applicant Information

Applicant Name: ___________________________________________________________________ Years in Wausau Region: __________________________

Applicant E-mail: ________________________________________________________________________________________________________________________

Home Street Address: ___________________________________________ City: __________________________ State: _____ Zip Code: _____________

Home Mailing Address: __________________________________________ City: __________________________ State: _____ Zip Code: _____________ (If different than street address) Home Phone: ___________________________________________________ Cell Phone: __________________________________________________________

Gender: Male Female No Answer Date of Birth: _______________________________________________________

Emergency Contact: ____________________________________________ Phone: ________________________ Relationship: ______________________

Employment Information

Employer Name: _________________________________________________________________________________________________________________________

Street Address: __________________________________________________ City: __________________________ State: _____ Zip Code: _____________

Mailing Address: _________________________________________________ City: __________________________ State: _____ Zip Code: _____________ (If different than street address) Employer Phone: ________________________________________________ Tenure With Employer: ______________________________________________

Business Industry: _______________________________________________

Job Title: ________________________________________________________ In Current Position Since: ___________________________________________

Briefly describe your present job responsibilities or activities. List your employment history (including military duty) beginning with the last position first.

Employer Title From To

200 Washington St Ste 120 | Wausau, WI 54403 www.wausauchamber.com 715.845.6231

Education Information

List your education history beginning with high school, college, business or trade schools and other specialized training.

Name of School City Degree Major

Involvement

List business/professional organizations in which you have been involved. Do not include civic organizations, public office or political activity.

Organization Office/Position Held From To

List community, civic, religious and other organizations in which you have been involved.

Organization Office/Position Held From To

Briefly state any contributions or achievements in these activities and explain your role. Please check the areas of volunteer and community service in which you wish to become more involved:

Arts Economic Development Government, Public & Legislative Affairs Children, Youth & Families Education & Training Health & Health Care Issues Communications & Public Relations Environmental Issues Recreation & Events Community Development Facilitation, Planning & Problem Solving Other: Diversity & Minority Group Issues Fundraising & Grant Writing

Program Expectations

What motivates you to apply for the Leadership Excellence program?

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

Tuition Information

Non-Refundable Application Fee WRCC Member Tuition Non-Member Tuition

$ ____________________ $ ____________________ $ ____________________

Applicant Acknowledgment & Agreement By applying for the Leadership Excellence program, I commit to active participation in the program through attendance, involvement and engagement with the opportunity for self-improvement and positive contribution to my employer/organization and community. I acknowledge I understand the commitment set forth in the Enrollment Guide and agree to all terms and commitment expectations.

Applicant Printed Name: _________________________________________________________________________________________________________________

Applicant Signature: ________________________________________________________________________________ Date: ______________________________

Employer Acknowledgment & Agreement (If Applicable) The above-named applicant has my/my business’ full support, which includes the time required to participate in the Leadership Excellence program. I also understand and agree that if the above-named applicant meets with the program administrator for a one-on-one meeting, but does not continue in the program, I am responsible for the non-refundable application fee and 50 percent of the tuition.

Business Name: ___________________________________________________________________________________________________________________________

Supervisor Printed Name: ________________________________________________________________________________________________________________

Supervisor Signature: _______________________________________________________________________________ Date: ______________________________

Submit Your Application Submit completed application and the $25 non-refundable application fee to Kim Smerda no later than May 15, 2014:

E-mail: Mail: ksmerda@wausauchamber.com Kim Smerda

Wausau Region Chamber of Commerce 200 Washington St Ste 120 Wausau, WI 54403

$ ____________________ $ ____________________ $ ____________________

TOTAL $ ____________________