First Name *

Last Name *

Cell Phone *

Personal Email *

How long have you lived in the Lansing area? *

Age *

Enter required value Under 25 25-35 36-50 50-Over

What is your gender identity? *

Enter required value Female/Woman Male/Man Non-binary Prefer to self-describe Prefer not to answer

Accessibility & Accommodations *

Dietary Restrictions & Allergies *

Do you have any dietary restrictions, food allergies, or sensitivities? If yes, please describe. If no, please put n/a

Organization *

Email *

Phone *

Address Line 1 *

City *

State *

Enter required value

Postal Code *

Employed Since *

Title *

Questionnaire *

Please upload a file containing answers to the below questions. PDF's only please!

1. Biography

Please write a brief biography in paragraph form to be featured in the orientation booklet 

2. Leadership Impact

Tell us about an experience or situation in which you assumed a leadership role and the results of those actions 

3. Personal Insight                                                                                                                                                   

What is one major issue facing Lansing that you are concerned about and what recommendations do you have for addressing this issue?

4. Participation

What qualities would you bring to Leadership Lansing? 

5 Community Involvement 

What professional organizations, business and community board service or volunteer opportunities have you recently engaged in?

6. Personal Statement

What do you hope to gain by participating in Leadership Lansing? 

7. Community Vision

What is your vision for the Lansing region?

20MB max

Tuition *

Tuition for the Leadership Lansing program is $2,800 per participant. Tuition is payable to the Lansing Regional Chamber of Commerce and is deductible under the Internal Revenue Service Code as a business expense. Companies with multiple applicants will receive a tuition discount of $250 per applicant.

Acknowledgment *

I have discussed with my employer my intention to participate in the Leadership Lansing program. I understand that attendance at ALL scheduled Leadership Lansing sessions is mandatory because my participation is essential to the program's success. I have received permission to be absent from work one full day a month. I have also discussed with my employer the importance of my participation in each session and that absence could result in my dismissal from the Leadership Lansing program. If for some reason I must withdraw from Leadership Lansing, notification must be given two weeks prior to the first class. If notification is given later than that, a $500 fee will be assessed.