Leadership Culver City Application
ALL APPLICATIONS ARE DUE JULY 15, 2018 (11:59pm PST)
Email address *
PERSONAL/DEMOGRAPHIC INFORMATION
Name *
Home Address (street number & name, city & zip code) *
Primary Phone Number *
Indicate type of phone number above *
Current Employer *
Employer Address (street number & name, city & zip code) *
Current Position & Length of Tenure in this Position (years) *
List your educational background: degree(s), major(s), school(s) *
List your current and past civic, professional and social organization where you held membership or leadership positions (include dates of participation/membership) *
List any special awards, certifications or recognition you have received *
GENERAL INFORMATION
How did you hear about Leadership Culver City? *
Why do you wish to participate in Leadership Culver City? *
What do you hope to gain from your Leadership Culver City experience? What are your expectations? *
How do you intend to use the skills and knowledge gained from this program? *
What qualities do you have that makes you a community leader (or potential one)? Give examples of how you have demonstrated these attributes. *
What do you consider your most important accomplishment in any of your leadership roles to date? *
What do you think are Culver City's three greatest assets? *
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