Application — Leadership Vallejo

Leadership Vallejo Application

Developing community leaders since 2008

Is Leadership Vallejo right for you?

Leadership Vallejo is a personal and professional development program designed to motivate participants to develop and enhance the quality of their leadership skills. Graduates will be equipped to effectively identify the needs of Vallejo and address them via positive community involvement.

Mission

Leadership Vallejo educates and trains future business, government, and volunteer leaders to gain the skills and experience needed to make the change you want to see in Vallejo and the world.

Are you ready to lead?

Complete Leadership Vallejo’s application for the Signature Program (7-10 minutes) and a team member will be in contact with you. Based on the initial application, only 50 applications will be selected to participate in an oral interview process. After the oral interview process, 25 individuals will be selected to participate in the upcoming class.

Secure your spot as a potential student! Submit your application and pay the $25 application fee here. This fee is non-refundable.

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1. CONTACT INFORMATION

Applicant's Name

First Name

Last Name

What name or nickname do you use?

Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Preferred Email

Cell Phone

(###)

###

####

Home Phone

(###)

###

####

2. EMPLOYMENT

Present or Last Employer/Business Name

Type of Business

Current or Last Position/Title

Start Date

YYYY

Briefly describe your responsibilities:

Employer/Business Website

http://

Business Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Office Email

Office Phone

(###)

###

####

Office Fax

(###)

###

####

Previous Employer

Previous Location

Previous Title/Responsibilities

From/To Dates

3. EDUCATION

Level of Education

Name and City of School

Dates Attended/Degree/Major

Apprentice or Certificate Program Completed

Name of School/Dates Attended/Certificate Received

4. ORGANIZATIONS/ACTIVITIES/COMMUNITY INVOLVEMENT

Please list, in order of importance to you, three (3) community, civic, professional, business, religious, social, athletic, and/or other organizations in which you have participated. Please describe the nature of your participation, responsibilities, accomplishments, and awards/recognition you received.

[4.1.] Name of Organization

Dates of Involvement/Position(s) Held

Please Specify

Appointed

Elected

N/A: Not Applicable

Briefly describe role/responsibilities:

[4.2.] Name of Organization

Dates of Involvement/Position(s) Held

Please Specify

Appointed

Elected

N/A: Not Applicable

Briefly describe role/responsibilities:

[4.3.] Name of Organization

Dates of Involvement/Position(s) Held

Please Specifiy

Appointed

Elected

N/A: Not Applicable

Briefly describe role/responsibilities:

If you have not participated in community activities, what conditions have changed that now enable you to seek involvement in the community and in what specific activities will you seek involvement?

5. YOU & VALLEJO

Years you have lived/worked in Vallejo?

Do you expect to be living in and actively involved in the Vallejo area in 5 years?

Describe any other community activities which exhibit your service in Vallejo.

Describe how you believe your participation in the Leadership Vallejo program will enhance your ability to become personally involved in activities and/or organizations in Vallejo. Please explain:

Explain in detail as to why you see yourself actively involved, in what areas, and why in the Vallejo area?

In your judgment what are two (2) pressing problems facing the Vallejo area today and why?

What do you hope to gain through your participation in Leadership Vallejo that may not have been addressed in the previous questions?

6. REFERENCES

Please provide the names of three (3) current business and/or personal references that can be contacted by the Selection Committee.

[6.1.] Reference Name/Email Address/Phone

[6.2.] Reference Name/Email Address/Phone

[6.3.] Reference Name/Email Address/Phone

7. TUITION

Tuition in the amount of $1,300.00 is non-refundable. A program material cost of $100.00 is required by the first class session; the balance of the fee may be paid by any club, organization, business, employer, or the participant. You may pay tuition in full or arrange to pay one-half of the Leadership Vallejo tuition, which is due prior to the first day of the program. The balance is due in full by December 31, and can be paid in installments.

Please indicate how your tuition balance will be paid:

If "Other", please specify

8. SIGNATURES

Applicant Electronic Signature

Date

YYYY

I make a commitment to meet all time, financial, and participatory requirements of the program.

(Full participation in this program is critical. If selected.)

Employer Electronic Signature

(Employer's signature needed, only if agreed to pay the participant's tuition)

Approval Date

YYYY

I understand the importance of full participation of the applicant, and if they are selected to participate, then I, as the Employer, will provide release time from work and will help them meet the requirements.