2021-2022 Leadership Program

 

 

    Leadership Redwood City, Belmont, Menlo Park, San Carlos Application

    First Name

    Last Name

    Address

    City

    Zip Code

    Home Phone

    Email

    Cell Phone

    How many years have you lived/worked in Redwood City/Belmont/Menlo Park/San Carlos?

    How did you learn about our program?

    My Employer



    Chamber website/email



    Referral



    Other



    Employment

    Currently employed?

    YesNo

    Present Employer

    Job Title

    Type of Business

    Industry

    Other


    Business Address

    City

    Zip Code

    Length of time with employer

    Business Phone

    Business Email

    Briefly describe your role/responsibilities

    Previous Employment

    Employer

    Title/Responsibility

    Dates




    More employment

    Employer

    Title/Responsibility

    Dates


    More employment

    Employer

    Title/Responsibility

    Dates

    Education & Training

    Name of School

    Degree/Certificate


    More education

    Name of School

    Degree/Certificate


    More education

    Name of School

    Degree/Certificate


    Other Academic Highlights or Achievements

    Organizations, Activities and Civic Engagement

    Please list, in order of importance to you, three community, civic, professional, business, social, athletic or other organizations of which you have been a member. Please briefly describe the nature of your participation, responsibilities, and accomplishments.

    Organization 1

    Date of Membership

    Describe Involvement


    Organization 2

    Date of Membership

    Describe Involvement


    Organization 3

    Date of Membership

    Describe Involvement


    If you have not been involved in any civic, business, professional, and voluntary activities, please explain why?

    What do you hope to gain as a result of your participation with Leadership, Redwood City/ Belmont/ Menlo Park/San Carlos?

    What are your areas of particular interest for leadership involvement in your community? Please rank from 1 through 10; 1 being your top rated topic of interest.

    Government

    Education

    Housing

    Economics & Business

    Transportation

    Land Use

    Public Safety

    Fundraising

    Health Care

    Getting started in volunteerism

    Other - Is there a topic related to our community, not listed above that you would like to learn more about?

    What is it about you that qualifies you for Leadership, Redwood City / Belmont / Menlo Park / San Carlos?

    Participation

    To successfully complete the Leadership Redwood City/Belmont/Menlo Park/San Carlos program, the participant must not miss more than 2 classes to graduate from the program.

    Participants must have the support and commitment of their employer if not self employed.

    Tuition

    Tuition for the Leadership Redwood City/Belmont/Menlo Park/San Carlos program is $1,500.00 and is due by the first class in September. Credit card payment is accepted. Checks should be made out to Redwood City-San Mateo County Chamber of Commerce.

    Other tuition funding sources, such as employer or sponsoring organization, may be utilized to pay for the participant's tuition.

    Please indicate how your tuition will be paid:

    SelfEmployerOther

    Please details instructions where to mail invoice. Complete mailing address with email address of contact required


    Refund Policy

    Withdrawal from the program following confirmation to participate may result in forfeiture of tuition unless Leadership Redwood City/Belmont/Menlo Park/San Carlos is able to confirm a replacement participant prior to the first session.

    I understand that completion of this application does not guarantee a candidate's acceptance into the program. I am aware of the attendance requirements and if selected to participate, I will devote the time required.

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