RETAIN Application

This is the application to join the 2025-2026 RETAIN Cohort! Please fill this out. Contact Andrea Tuttle with any questions at Andrea.Tuttle@GreaterRochesterChamber.com. Please note, this program is intended solely for individuals with full-time employment in Monroe County.

Fields marked with an * are required.

RETAIN Application Form

Legal First and Last Name *

Preferred Name *

Date Of Birth *

Cell Phone Number *

Home Address *

Personal Email Address *

Emergency Contact Information

Emergency Contact Name *

Emergency Contact Relationship *

Emergency Contact Phone Number *

Employer Information

Work Email Address *

Employer Name *

Employer Address *

Employer Type (for profit, non-profit, government, etc...)

Supervisor Name and Title *

Your Current Position/Job Title *

Current Salary (Salary only, not including benefits or bonus) *

Is your employer a minority or women owned business?

Education

Highest Level of Education Completed? *

Most recent education completed. Including school, program and/or certification name *

When did you graduate from your most recent educational program? (2-year, 4-year, trade school) *

Community Engagement

Please tell us about any volunteer or community service experiences that have been rewarding to you

Are there local organizations, causes, or initiatives you currently support *

yes

no

If yes, share how you prioritize community engagement with your personal and professional life

Are you interested in joining any professional associations, networking groups, or community orgs?

yes

no

How long do you plan to stay in Rochester *

Where did you live before school, if not in the Greater Rochester region?

Why Retain?

How did you hear about RETAIN *

What specific skills or competencies do you hope to develop through participating in RETAIN? *

Demographics
At Greater Rochester Chamber of Commerce, we believe that diversity, equity, inclusion, and belonging aren’t buzzwords – they are our game-changing competitive advantage and we invite you to review our DEI statement. The following questions are optional.

Gender Identity

Male

Female

Non-Binary

Other/Prefer Not to Answer

Preferred Pronouns: She/Her/Hers, He/Him/His, They/Them/Their, other

She/Her/Hers

He/Him/His

They/Them/Their

Other/Prefer Not to Answer

Which of the following race/ethnicities do you identify with? Check all that apply

American Indian or Alaska Native

Asian

Black or Afriacn American

Hispanic or Latino

Native Hawaiian or Other Pacific Islander

White

Other/Prefer Not to Answer

Are you a Veteran

Yes

No

Will you require any accessibility accomidations for full participation in the RETAIN sessions?

Yes

No

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RETAIN Application

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