Foundation of the Delaware County Chamber of Commerce
Business Leadership Academy
. . . the quality of our leadership will determine the future of Delaware County
The Foundation of the Delaware County Chamber of Commerce brings you the Business Leadership
Academy.
CONFIDENTIAL APPLICATION INSTRUCTIONS
Please type or print clearly and complete each section fully. Limit answers to the space available.
Application must be signed by both applicant and employer/sponsor and returned no later than August 31,
2015 to Business Leadership Academy, Foundation of the Delaware County Chamber of Commerce
(FDCCC), 1001 Baltimore Pike – Suite 9LL, Springfield, Pa 19064 For more information call 610- 5653677 or e-mail foundation@delcochamber.org.
SELECTION CRITERIA
Participation in the BUSINESS LEADERSHIP ACADEMY (BLA) is open to persons living and/or working
in Delaware County. A maximum of twenty individuals will be accepted to participate in the program each
year.
The FDCCC BLA committee, based upon the information completed on this application act as the selection
committee. The Committee will be seeking representation from a cross section of the community. These
leaders and potential leaders will be active in business, education, the arts, religion, government; community
based organizations, ethnic and minority groups and will reflect the diversity of the community.
Applicants must have the full support of the organization or corporation they represent.
Attendance at all sessions is expected. Those who fail to attend may be asked to withdraw with no refund of
tuition.
--------------------------------------------------------------------------------------------------------------------------ENROLLMENT AND TUITION
Enrollment in the program is limited, and candidates are selected based on their commitment and potential
talent for community leadership. Tuition is $1,200 for Chamber members, $1,500 for non-members.
Applicants selected may have all or part of their tuition paid by an employer or sponsor, or with a limited
number of partial scholarships awarded. Included in the tuition fee are all program materials, attendance at the
Chamber’s Annual Dinner, Small Business Lunch and Chamber’s Annual Lunch where the class will be
recognized. Mail or email your completed application to the Delaware County Chamber of Commerce,
attention: Foundation. Payment is required prior to the first class. Checks should be payable to The
Foundation of the Delaware County Chamber of Commerce.
2015-2016 BUSINESS LEADERSHIP ACADEMY
APPLICATION FORM
(PLEASE PRINT CLEARLY OR TYPE)
Name: ____________________________________Current position/title: _____________________
Business/organization: _________________________ Dietary restrictions: No Yes________________
Business address_____________________________ Home
Address________________________________
City___________________ State_________ Zip_____ City______________ State_________Zip__________
Phone (____)____________________cell(___)____________________fax (___)_________________
email__________________________________
How did you learn about Business Leadership Academy? ___________________________________
________________________________________________________________________________________
Post high school education: (schools attended, field of study, degrees, and professional training programs, etc.):
_______________________________________________________________________________________
_______________________________________________________________________________________
Career background: (places of employment, positions held, years of employment):
________________________________________________________________________________________
________________________________________________________________________________________
Present job responsibilities:
_______________________________________________________________________________________
________________________________________________________________________________________
Skills necessary to fulfill these responsibilities: __________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Identify the ways in which you have demonstrated leadership:____________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Tell us about your leadership role in your community and what learning experience would better help you
to serve in that role:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
687321111
Volunteer activities (past and present):
Organization/activity
involvement
date(s) of involvement
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
What do you expect to get out of this program? ________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
List any community activities (committees, boards, commissions, etc.) With whom you would like to become
involved:_______________________________________________________________________________
________________________________________________________________________________________
Describe your long-range goals (where do you see yourself in five years?)___________________________
_______________________________________________________________________________________
Identify a particular challenge; issue or problem you feel is critical to the community. How do you see your
involvement with this issue?
________________________________________________________________________________________
________________________________________________________________________________________
_______________________________________________________________________________________
COMMITMENT
Participants must attend at all of the sessions, participate in the Comcast Cares Day (Saturday, April 30), and
participate in the Nonprofit Fellowship (attend board and commitment meeting of their assigned
nonprofit). Please be sure to complete the attached Fellowship interest form If selected, can you devote
the required time to this program? _____yes _______no
Applicant’s signature__________________________________________date________________________
Each applicant to the Business Leadership Academy must have the support and commitment of his/her
business or organization. The signature of his/her supervisor below or a letter of support from this
individual should accompany application.
Name___________________________________________________Title_____________________________
Business/organization______________________________________________________________________
Phone (____)____________________
email__________________________________
Address_________________________________________________________________________________
City___________________________________________state____________zip_______________________
Signature______________________________________
Application should be completed and forward to FDCCC by August 31, 2015
(email to foundation@chamber.org)
687321111
Foundation of the Delaware County Chamber of Commerce
Fellowship Interest/Selection
NAME__________________________________________
List your five (5) choices /areas of interest as the list of fellowship sites is still in development. Please indicate in order of
preference (see below categories)
1.________________________________________________
2.________________________________________________
3.________________________________________________
4.________________________________________________
5.________________________________________________
Comments:
Categories of Nonprofits and samples:
 Arts
o Media Theater
 Educational (including individuals with intellectual and developmental disabilities
o Library
o Literacy Council
o Foundation of the Delaware County Chamber of Commerce
o The ARC of Delaware County
 Economic Development
o Community Development Organization
o Chamber of Commerce
 Housing
o Community Action Agency
 Health Care and Healthy Living
o Hospitals
o YMCA’s
o Athletic Associations
 Preservation
o Delaware County Historical Society
 Social service
o Domestic Abuse Program
o Red Cross
o Senior Programs
 Transportation
o Delaware County Transportation Association
o Community Transit
 Youth
o Big Brother Big Sister
If there is a nonprofit or public entity that you are interested in and it is not represented on our list, it is possible that we
can contact them to ask if they are willing and able to participate as a Fellowship site. Speak directly to the Executive
Director as soon as possible about this and your options so as not to delay starting the fellows
687321111