Applicant's First Name *

Applicant's Last Name *

How do you want your name to appear on a name tag? *

Home Address *

(Including suite, apartment, or unit #)

Home Address- City, State, Zip Code *

Full Business Address (Including City, State, and Zip Code) *

Home/Mobile Phone number *

Business Phone number

Preferred Email Address *

Please list the email at which you'd prefer to be contacted for all Experience Greensboro communications.

Alternate Email Address *

Please include an additional email at which you wish to be contacted.

Check All That Apply *

Please check all of the boxes that apply to you

Previous participant of Leadership Greensboro

Previous participant of Experience Greensboro

Previous participant of Other Voices

None of the above

List the name of any other community leadership programs in which you previously participated.

How did you learn about Experience Greensboro? *

Applicant's Date of Birth *

(MM/DD/YYYY)

Gender *

Race *

Check all that apply (Required Field)

Enter required value African American/Black American Indian/Alaska Native/Native American Asian Caucasian/White Hispanic/Latino Pacific Islander/Native Hawaiian Other Identification

If Other Identification checked, please explain below

EMPLOYMENT

Current Employer Name *

Is your current employer/company a member of the Greensboro Chamber of Commerce? *

Enter required value YES NO

Current Title *

COMMUNITY INVOLVEMENT

Community Involvement History

Please list present and past community, civic, religious, political, social, etc. involvement. Include all three: organization name, position held, and dates

GENERAL INFORMATION

How do you feel the Experience Greensboro program will benefit you?

This could include benefits that are both personal and professional. 

TUITION

The tuition for Experience Greensboro is $600 and applicants must be members of the Chamber of Commerce. If you are unsure if your organization is a member, please contact the Program Director.  The tuition may be paid by the individual, an employer, agency, organizations or other source. You will be invoiced upon acceptance to the program.

Tuition for Leadership Greensboro will be paid by: *

Enter required value Employer Participant Both Employer & Participant Other

Please list any physical challenges or medical conditions.

The following information is collected in advance for use only after participants are selected for the class to ensure a good experience in the program. 

Please list any dietary restrictions or food allergies. *

Applicant Acknowledgements: *

TUITION ACKNOWLEDGEMENT
Tuition for Experience Greensboro is $600 and applicant/organization must be a Member of the Chamber of Commerce. Tuition is not due with the application; you will be invoiced upon acceptance. Tuition must be paid by February 15, 2025 to prevent dis-enrollment from the program - No exceptions.

APPLICANT ACKNOWLEDGEMENT
I understand the purposes of the Experience Greensboro program and if I am selected, I will devote time (as set forth in the Participant Commitment & Attendance Policy) and resources necessary to complete the program. I also affirm that all of the above information in this application is accurate to the best of my knowledge and that this application was completed by me, the applicant.

Please affirm both statements below by adding your full name.