Leadership Greater Waterbury Application

Leadership Greater Waterbury Class of 2025-'26 Application

* Indicates required field

Name *

First

Last

Title *

Company *

Company Address *

Line 1

Line 2

City

State

Zip Code

Country

Work Phone *

Cell Phone *

Work Email *

Please list any volunteer activities you are a part of: *

What do you hope to gain from participating in this program? *

What qualities or experience would you bring to the program? *

What are you passionate about when it comes to your community? *

List your top three areas of concern in the Waterbury region: *

Education: Begin with high school, include degrees awarded and fields of study: *

Dietary Requirements (allergies or other restrictions): *

I understand that attendance at Orientation Days, October 22 and 23, 2025, is mandatory for acceptance into the program. Other attendance requirements will be shared during the application process. *

Yes

We will be conducting Info Sessions September 10, 11, and 12, in Waterbury, for all applicants. Please share your preferred two-hour window during that time. We will confirm your specific session time after all applications have been processed. *

Program Investment: Business participants - $1,650; small businesses - $1,100 (under 25 employees); non-profit agencies - $950. Breakfast, lunch and materials are included in the fees.
Application deadline is September 5, 2025.

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