Preparing Business and Community Leaders

A program of the Shiawassee Regional Chamber of Commerce, Baker College of Owosso & the Cook Family Foundation

Leadership Shiawassee Confidential Application

Enter the information and click the Submit button. You will then be able to pay the tuition using our secure shopping cart.

*Mandatory Field

*Name
*Home Address
*Home Phone
*E-mail Address
*Employer
*Job Title
*Business Address
*Business Phone
Business Fax
Employer's E-mail Address
*Years in Position
*Birth Date
*How may years have you lived in the Shiawassee area?
*How long do you expect to remain here?	1-5 years 5+Years

*Community Involvement

Please list civic, religious, political, professional, social or other activities. Show official positions held.

*Sponsoring Employer, Organization, Agency

Name and Title	Address


Candidates recommended by 1996-2010 alumni will receive first consideration.

*Motivation

Why are you motivated to take this class?
(One paragraph)

Agreement

I understand the attendance requirements. I will devote the necessary time and energy to complete the program.
I have the cooperation and support of my employer.