Fellows Intake Form : Fellows Program : Programs & Services

Leadership Cumberland 2024-2025 Fellows Intake Form

Congratulations on being accepted into our 2024-2025 Class of Fellows! We look forward to meeting you and having you in class. Please take a moment to fill out our intake form below so that we can start to get ready for our first class. If you have any questions or concerns please reach out to our Fellows Program Director, Nicole Deary, at director@leadershipcumberland.org.

Date:

Name:

First Name *

Last Name *

Age:

Pronouns

(e.g. she/her, he/him, they/them, etc.)

Ethnicity

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Occupation Industry

What is your unisex t-shirt size?

If you have a disability that you would like accommodations for to participate in the program, please list them here:

Are you a veteran or active in the military?

Do you have any food allergies or dietary needs? If so, please list.

What is one FUN Fact about yourself?

Interesting information about a hobby/passion, accomplishment, or life event.

What is one BORING fact about yourself?

Interesting information about the mundane parts of your life.

Is there anything else you'd like to tell us about yourself?

Which orientation will you be attending?

Sept 4 - Carlisle Chamber
Sept 10 - West Shore Chamber
Neither of these dates work for me

Each orientation is in person and from 9 am - 10 am.

Preferred Email:

Signature: