Leadership Corvallis Application The Class of 2024 applications are available now! Have you always wanted to be a community leader? Do you want to meet the people that make the Corvallis community run? Are you interested in making connections that will promote your professional growth? If so, apply to be part of the next Leadership Corvallis class. The program, which just marked its 30th anniversary, brings together a cohort of like-minded residents interested in impacting their community. Daylong sessions are held once per month from September through June (second Thursday of the month from 9am to 5pm). Topics include health care, government, human services, education, the arts and natural resources. Participants meet community leaders and take field trips to locations throughout the community. Tuition is $700. Applications received by June 30, 2023 will receive a $50 early bird discount. This application requires a $25 deposit and the $675 balance will be due upon acceptance into the class. For more information about the application process please contact recruit@leadershipcorvallis.com. Applicant Information: (Please submit your name the way you want it on your class name badge)Name(Required) First Middle Initial Last Home Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Preferred Contact Email(Required) Preferred Contact PhoneApplicant Information:(if self-employed or retired, please state that in the current employer section)How many years have you lived/worked in Corvallis?(Required) Current Employer(Required) Title/Position Work Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Billing Address(Required)WorkHomeApplication QuestionPlease keep your answer concise (recommended 1-2 paragraphs).Please share why you're interested in participating in the 2023/24 Leadership Corvallis program(Required)PROGRAM COMMITMENTPlease read and check the box next to each line to indicate you have read and understand your commitment to the Leadership Corvallis program.Policies(Required)I have read and agree to abide by the Leadership Corvallis policies on substitutions, cancellations and refunds, tuition payment, and graduation. These are posted at leadershipcorvallis.com/program Agree(Required)Respect(Required)I will respect fellow class members, the class host and speakers by being on time, staying for the entire session and minimizing distractions such as use of my cell phone or tablet. Agree(Required)Attendance(Required)I commit to attending and completing all classes. If unable to attend a class I will notify the Program Host. If an emergency forces my absence, I understand I may be eligible to make up class sessions the next year in order to graduate depending on space availability. At least an 80% attendance (8 of 10 classes) is required for graduation. Agree(Required)Volunteer(Required)I understand that Leadership Corvallis is an all-volunteer organization that depends on the time and talent of alumni to maintain the program. I am willing to volunteer with Leadership Corvallis following my class session if my time and talent can further the mission of the organization. Agree(Required)Cancellation(Required)I understand that in the event of a class being cancelled due to circumstances beyond the control of Leadership Corvallis, the organization will make reasonable effort to make up the class and I will make reasonable effort to participate. Agree(Required)Photo Release(Required)I understand that Leadership Corvallis may record my participation and appearance on video, audio or in photographs, or in any other recorded medium. I understand that these recordings may be used in any medium, including print, Web, video, or audio. I consent to Leadership Corvallis' use of my name, likeness, voice, and biographical material in connection with recordings in whole or part without restrictions or limitation for any educational or promotional purpose, which Leadership Corvallis and those pursuant to its authority, deem appropriate. I waive any right I might have to inspect and/or approve the finished medium, or the use to which it may be applied. Agree(Required)ScholarshipsLeadership Corvallis has a limited about of scholarships to help cover tuition (up to 50%). Would you like to apply for a scholarship? Yes No Please describe your need for scholarship assistance in 2-3 sentences.If you receive scholarship assistance to participate in Leadership Corvallis, please describe in 2 or 3 sentences how you intend to "pay it forward" and honor the scholarship. How could yourself or your business give back to the community or Leadership Corvallis?Signature(Required)Sign with a mouse, stylus or your finger on a touch device Reset signature Signature locked. Reset to sign again Today's Date MM slash DD slash YYYY After clicking Submit Application below, you will be taken to the Corvallis Chamber site where you will make your $25 Application fee payment. Your application is not complete until you make this payment. When you make this payment please use the same email address as the "preferred email" above so that we are able to keep all payments and applications together. CommentsThis field is for validation purposes and should be left unchanged.