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The Academy for Dairy Executives

Developing Management and Leadership Skills

Registration is now open for the 2014-2015 Academy for Dairy Executives in Northern NY

Application For Admission - Due by October 15, 2014

The following information will be kept confidential, with the exception of information in questions 1, 2, & 4 which will be used in the participant section of the "Academy" binders. You may fill out the following online application. Please don't forget to press SUBMIT after filling out the form.

1. Personal Information

Name:
Informal or Nickname:
Title/Position:

Preferred Mailing Address:

Street Address:
City:
State:
Country (if other than USA):
Zip:
Home Phone: (Area Code): (Number)
Cell Phone: (Area Code):   (Number)
E-mail:

2. Business Information

Firm Name:
Business Address (if different than above, fill in entire address, including zip: (Optional)
Business Phone: (Area Code): (Number):
Preferred Method of Communication (for program related materials):
Home Address
Business Address
Email

3. Briefly describe your responsibilities in the management of the business.

4. Please provide a short paragraph about your business that can be shared with the faculty and other participants to help them get to know you. This will be printed in your own words in the “participant description” portion of the binders. Please do not omit this portion of the application.

5. What are the primary activities of your business?

6. Explain why you wish to attend the Cornell Dairy Executive Program.

7. What skills, interests and input would you bring to class participation?

I agree to have my name printed on a list, without any contact information, for sponsors.

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Please return completed application by October 15, 2014 to:
Peggy Murray
Cornell Cooperative Extension of Lewis County
PO Box 72, 5274 Outer Stowe St
Lowville, NY 13367
Phone: 315-376-5270
E-Mail: MLM40@cornell.edu