Apply to LGS!

APPLICANT INFORMATION
First and Last Name*
(First and Last Name)
Middle Initial
Nickname
Referred to LGS by*
Home Contact Information*
Street
City*
State*

ex. NY
Zip*
Personal email*
Personal Phone (land line if available)
Mobile*
Employer*
Work Contact Information*
Street Address City State ZIP
Work Phone*
Work e-mail*
Email address preference to receive all LGS correspondence*
Number of Years in CNY*
How did you learn about Leadership Greater Syracuse?*
- LGS Website
- Social Media
- Co-worker / Employer
- Presentation / Event
- LGS Graduate(s)
- Other
Please be specific
Names, Events, Presentations.
PERSONAL INFORMATION
Completing this section is optional; however, LGS uses this information soley for the purpose of ensuring the diversity of the class.
Age
Race
I identify my gender as:
Do you have any dietary constraints or physical limitations?
- Yes
- No
If yes, please describe
Check here if you do not want to have your picture taken.
- Don't take my picture

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EMPLOYMENT
Career Type*
Which of the following categories best describes your current employer?*
Other*
Title*

Current job title
Describe your current job responsibilities*
What do you consider your most significant professional contribution or achievement in the past 5 years?*
List previous 3 positions held during the past 5-10 years beginning with your current or most recent employer:*
Employer Title / Responsibility Dates
List business or professional organizations in which you have been active; for example, SHRM, Toastmasters (Do NOT include community involvement).
EDUCATION
Level of Education - Please indicate highest degree obtained:*
- High School
- Associate's
- Bachelor's
- Master's
- Doctorate
- Other
Other
List, beginning with most recent - High School, College(s), Advanced Degrees, and Specialized Training where applicable.*
Name of School City / State From - To Degree / Major Completed?
COMMUNITY INVOLVEMENT
Please list, in order of importance to you, any civic, religious, community, athletic, social or other organizations, either inside or outside the Greater Syracuse area, of which you are, or have been a member. Please note any leadership positions held.
Volunteer Interest*
Community Service*

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APPLICANT INFORMATION

Employer	Title / Responsibility	Dates

Name of School	City / State	From - To	Degree / Major	Completed?

Name of Award	Type of Award	Year Received