Leadership Jefferson Class of 2019
Thank you for applying for the Leadership Jefferson's Class of 2019! Please fill out the below information.
Email address *
First Name *
Your answer
Last Name *
Your answer
I have reviewed the dates and time commitment for the Class of 2019. I can attend Opening Retreat, all Monthly Sessions, and Closing Session. *
Required
Gender
Home Street Address
Your answer
Home City, State, Zip Code
Your answer
How many years have you lived and/or worked in Jefferson Parish?
Your answer
Cell Phone Number (include area code) *
Your answer
Email *
Your answer
Job Title *
Your answer
Company Name *
Your answer
Company Street Address *
Your answer
Company City, State, Zip *
Your answer
Company Phone Number (include area code) *
Your answer
Supervisor's Name *
Your answer
Supervisor's Title *
Your answer
Supervisor's Address ( if different from above)
Your answer
Supervisor's Phone Number (include area code) *
Your answer
Supervisor's Email *
Your answer
My company would be interested in the following? *
Sponsoring an event, breakfast, or lunch would include signage and promotional opportunities for your company at our session.
Required
Education
Please share any graduate diplomas/degrees earned.
Your answer
Professional *
Please describe your current position's responsibilities with your company.
Your answer
Community Involvement
Please list any volunteer work to which you have devoted time.
Your answer
Awards
Please list any awards earned in the past 5-10 years. These awards can be professional, personal, or academic.
Your answer
Personal Hobbies
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Local Interests *
In your opinion, what are the three most pressing issues facing Jefferson Parish and the greater New Orleans region?
Required
What do you hope to gain from participating in Leadership Jefferson? *
Your answer
Personal Recommendations *
Please list 2 references. Please include Name, Title, Company, and Email
Your answer
How did you hear about Leadership Jefferson?
A copy of your responses will be emailed to the address you provided.
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