SWCRC Leadership 21 2021 - 2022 Application
RequiredRequired Question(s)
Required 1.
Please enter the information indicated below.

First Name:
Last Name:
Company Name:
Work Phone:
Email Address:
Address 1:
Postal Code:

Required 2.

Paste your resume here. 

  • Include a current resume or additional sheets that include any of the following:
  • Previous employers and positions
  • Educational background, including degrees, professional certifications, etc.
  • Extra-curricular activities
  • Special honors, awards, and recognition
  • Volunteer/community involvement, including duties, board positions, etc.


1000 characters left.
Required 3.
Personal Recommendation:
List three people who are personally knowledgeable about your leadership performance and potential.  Provide their phone number and/or email address.

350 characters left.
Required 4.


  • Attendance at one-day orientation is mandatory.
  • No more than one absence is permitted.
  • Employer support for your time involved is critical.
  • Tuition for each participant is $250.
I fully understand the commitment required and will devote the time and resources necessary to be a successful participant in Southern Wayne County Regional Chamber's Leadership 21.

I Agree With This Commitment
I Do Not Agree to this Commitment
  • Comment:

  • 500 characters left.
Required 5.


What do you consider your most important accomplishment in any of the business, professional, or job related organizations that you listed previously? Why? What role did you play?


1000 characters left.
Required 6.
What, in your opinion, are your top three leadership traits?

1000 characters left.
Required 7.
What specific skills/knowledge do you hope to gain from your participation in Leadership 21?

1000 characters left.
Required 8.
In your judgement, what are the three most pressing problems facing the Southern Wayne County area?  Explain your choices and give any recommendations you may have for approaching and resolving these problems.

1000 characters left.
Required 9.

Why should you be considered as a participant in Leadership 21?


1000 characters left.