Allamakee Leadership Institute Application

Applicant Contact Info

Full Name *

Preferred Name (if different)

Email Address *

Phone Number

Your Organization

Organization/Employer *

Job Title/Role *

You As A Leader

What motivated you to apply for the Allamakee Leadership Institute? *

What leadership responsibilities are you currently trusted with? *

What leadership skills or capacities are you most interested in strengthening through this program? *

Describe a leadership challenge you are currently navigating. *

Applicant Agreement & More

The program includes monthly in-person sessions (September–February, first Thursday of the month, 9:00 AM–2:00 PM). Are you able to commit to attending? *

Yes
I have a scheduling conflict but would like to discuss
Unsure at this time

I understand this program emphasizes discussion, reflection, and confidentiality within the leadership group. *

Yes, I understand and agree

Is your employer aware of your interest in this program? *

Yes
Not yet, but I plan to discuss if accepted
I am self-employed

If applicable, how is your employer supporting your participation? *

Is there anything else you would like us to know as we review your application? *

Tuition & Payment

Full tuition is $375.00

How would you like to pay the fee? *

Via check
Via credit card

Full tuition

Check Info

Checks can be made out to Allamakee Economic Development and mailed to 101 W Main St Waukon, IA 52172.

Convenience Fee *

Price: $ 14.07

All transactions submitted online are subject to PayPal convenience fees.

Total

360.00

Developing leaders. Connecting community.