Leadership Whatcom Application

Basic Info

Disclaimer: The Bellingham Regional Chamber of Commerce will not sell or distribute your contact information, personal data, or employment history. This data will be stored for purposes of the program and alumni contact program and is only accessible in its entirety by our internal Chamber staff and the contracted Educational Coordinator.

Name*

First Last

What are your pronouns?

This is not a required question.

Name for name tag, recognitions, and awards

First Last

Do you have any dietary restrictions or allergies?*

Please let us know if you have any needs that will make this program more accessible to you. (ASL interpretation, live transcription, translation services, etc).

Cell phone*

Work phone

Home phone

Which is your preferred phone number for the program?*

What is the best time to reach you by phone?*

Personal email*

Work email

Which is your preferred email for the program?*

Home address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Employer Info

If not currently employed, please use "N/A" for Employer and Title boxes, and please use your home address again for Work address. Thank you.

Employer*

Title*

Work address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Emergency Contact Info

Leadership Whatcom programs include field tours and group learning activities. Your contact person information will be held confidentially and will not be added to any LW program databases or outreach lists.

Emergency contact*

First Last

Emergency contact phone*

Relationship to you*

A bit more about you ...

Date of birth*

Gender Identity

This information ensures the Leadership Whatcom participant group reflects the diversity of our country. It is not a prerequisite for participation.

Race/Ethnicity

This information ensures the Leadership Whatcom participant group reflects the diversity of our country. It is not a prerequisite of participation.

Length of time living in Whatcom County*

From your perspective, what other elements of diversity would you bring to Leadership Whatcom?*

If you are retired or not currently employed, please briefly describe a recent job experience or employer that is meaningful to you?*

Title/Position*

Please list your last ten years of employment history, educational history or degrees, current and prior community and professional involvement, e.g., organizations, grassroots efforts, and/or elected positions. Include approximate dates of involvement and leadership roles, and any other information you think might be helpful to the selection committee.*

On average, how much time each month do you spend on civic or volunteer activities? e.g., school board, community service, elected positions?*

Please respond to the following questions.

1. What motivated you to apply to this 9-month leadership program?*

2. What skills or strengths do you bring to Leadership Whatcom?*

3. How do you envision putting your Leadership Whatcom education into action in Whatcom County following completion of the program?*

4. What do you think are the qualities of a successful leader?*

Reference #1*

First Last

Please list local references that have knowledge of your leadership experience/qualities. Contact information for your references will be stored for the duration of your program and used for invitations to your program graduation and/or recognition

Reference # 1 - Relationship*

Reference #1 - Phone*

Reference #2*

First Last

Please list local references that have knowledge of your leadership experience/qualities. Contact information for your references will be stored for the duration of your program and used for invitations to your program graduation and/or recognition

Reference #2 - Relationship*

Reference # 2 - Phone*

Reference #3*

First Last

Please list local references that have knowledge of your leadership experience/qualities. Contact information for your references will be stored for the duration of your program and used for invitations to your program graduation and/or recognition

Reference # 3 - Relationship*

Reference #3 - Phone*

Personal Commitment Form*

TIME: I understand that the Leadership Whatcom program is comprised of a one-day Orientation Session, followed by monthly day-long, and the culminating May session and graduation celebration. Participants will use these months to test and apply leadership skills. I agree to attend ALL sessions. I understand that in order to complete the program, I must participate in all sessions, and that any participant missing more than 30 minutes of any session may be asked to withdraw from the program and that no portion of the tuition shall be refunded. Leadership Whatcom recognizes that emergencies do arise and is willing to accommodate some special circumstances.

TUITION: Tuition for Leadership Whatcom is $1,200 for Chamber members and $1,500 for non-members, with payment in full is due by Monday, October 2, 2023.

COMMITMENT: I understand the purpose and scope of the Leadership Whatcom program. If I am selected, I will participate fully and devote the time and resources necessary to complete this program, including class time, out-of-class time, and tuition. I understand that the intent is to increase my own leadership capacity and support the learning of other participants while exploring leadership skills and the issues affecting Whatcom County. I agree to support and follow the ground rules as developed by the class at the orientation and throughout the program. I understand the above commitment and agree to be bound to it by signing this application.

Today's Date

Tuition fee is not collected with your application. Upon acceptance to the program, you will be invoiced. The tuition price is $1200 for Bellingham Regional Chamber members and $1500 for non-member businesses and organizations. Scholarships will be offered upon acceptance to the Leadership Whatcom program.*

Chamber member - $1,200
Non-member - $1,500

I would like to be considered for a scholarship.

Yes

Scholarships will be evaluated by the BRCC staff based on applicant's ability to pay the registration fee and the diverse perspectives that the applicant will bring to the class dynamics. Priority is given to chamber members.

Total

$0.00

Leadership Whatcom Application

Basic Info

Employer Info

Emergency Contact Info

A bit more about you ...

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