Dalton-Whitfield Chamber of Commerce
890 College Drive
Dalton, GA 30720

Phone 706-278-7373 - Fax 706-226-8739
email info@daltonchamber.org

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Emerging Leaders Institute Application Form
Click here for a PDF Emerging Leaders Institute Application

Anyone interested in participating in a future Emerging Leaders Institute class, should complete and submit the application form below. 

Application Form:

 Today's Date:  
 Date of Birth:  
 Sex:  
 Race/Ethnicity  
 Name (and nickname):  
 Home Address (include street, city, state & zip)  
 Home Phone:  
 Spouse's Name:  
  Indicate # of years you have lived in Dalton and Whitfield County:  
# of Years: 
 If you live outside of Whitfield County, indicate the number of years:  # of Years:
 Education:  
 Employer:  
 Category (check one)  
 Bank/Financial  Non-Carpet Big Business
 Carpet/Carpet
     Related		  Non-Carpet Small Business
 Clergy  Not-for-profit
 Education  Professional
 Government  Utility
 Healthcare  Volunteer
 Business Address (include street, post office box, city, state & zip)  
 Business Phone:  
 Business Fax:  
 Business Email:  
 Job Function/Title:  
 Civic, professional
or volunteer activities:		  
 How would you benefit from  leadership training and development?
 How would you use your leadership training to benefit the community?  
A limited number of partial scholarships may be available.  Do you need to be considered for a partial scholarship?  

Thank you for submitting an application to be considered for the Emerging Leaders Institute.  The Steering Committee selects each class and will notify those individuals that have been selected to participate.

 

 

 
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