Leadership Greater Waterbury Application

Leadership Greater Waterbury Class of 2024-'25 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): *

Program Investment: Business participants - $1,350; small businesses - $950 (under 25 employees); non-profit agencies - $850. Breakfast, lunch and materials are included in the fees.
Application deadline is September 6, 2024

Submit