Class of 2020 Leadership Program Application
Before completing the application, please ensure you're able to attend the 10 Program Days and the mandatory 2-day retreat on September 6-7, 2019. (Program dates are available on the website.)

Please provide the information requested below. It's best to complete this application in one sitting to ensure your answers are saved.

You may also download a PDF of this application at www.leadershipprogram.net.

Deadline: Wednesday, May 1, 2019. Candidates will be notified by July 1, 2019.

Questions? Contact Margi Power, Program Director, at (650) 401-2444 or margi@leadershipprogram.net. Thank you!

Email address *
Personal Information
Full Name *
First, Middle and Last name
Your answer
Personal/Cell Phone number *
Your answer
Birthdate
MM
/
DD
/
YYYY
Gender
Preferred Pronoun
Home Address
Your answer
Home Community?
For purposes of this program, what should we consider your “home” community? Leadership includes participants who live OR work in San Mateo, Foster City, Burlingame or Hillsborough. You may have affiliations with one or more of these communities. Please explain which one you might like to represent in this program and why.
Your answer
Emergency Contact Name, Relationship to you and Phone Number
Your answer
Employment and Professional Experience
Current Employer
Your answer
Sponsoring Organization/Business (if different from your current Employer)
(Indicate your current Employer, other organization, or N/A if not applicable). "Sponsoring organization" means they will cover the cost of your tuition.
Your answer
Name and Contact Information of Person at Sponsoring Organization
Applicants for the Leadership Program must have the support and commitment of their sponsoring business or organization, if applicable (put N/A if not applicable). (Note: a sponsoring organization is not required for admission into the program.) Please indicate the full name, title and contact information for the person at the sponsoring organization (in the space below), if applicable, as indication of their support for your participation in Leadership.
Your answer
Your Business Address
Your answer
Your Business Phone Number
Your answer
Your Business Email Address
Your answer
LinkedIn Profile
Your answer
Briefly describe your interest in the Leadership Program, what you hope to gain and how you expect to utilize your Leadership Program experience.
Your answer
What makes you a compelling candidate for this program? Please consider your leadership experience and/or future plans and goals, both professionally and in the community.
Your answer
What does the word "Leadership" mean to you?
Your answer
Please give an example of an impactful use of leadership skills, either that you executed or that you observed in someone else.
Your answer
Education
Please list your education background including degrees awarded, field of study, professional institutes, training programs, etc. Include special honors or awards.
Your answer
Organization/Business, Professional and Volunteer Activities
Please list major civic, business, professional and voluntary activities in which you have participated, including your role. Please include any offices you have held. Also list awards, or any special recognition that you have received. Community involvement is a key selection consideration.
Your answer
Employment History
If employed, please list current employer, current job title and brief description of job duties. Please also briefly list past employers, length of employment and area(s) of responsibility.
Your answer
References
List two people who have knowledge of your qualifications. (Note: the Selection Committee may contact these individuals.) Include First and Last Name, Email Address and Phone Number.
Your answer
Leadership Program References
If applicable, list 1-2 people you know who have previously participated in Leadership San Mateo, Foster City, Burlingame, and Hillsborough. (Note: the Selection Committee may contact these individuals.) 1) Include First and Last Name, Email Address and Phone Number; 2) Please indicate your relationship to these Leadership Alum(s) and whether they are recommending you for the program.
Your answer
Tuition and Fees
Total tuition and fees for the 2019-2020 Leadership Program are as follows:
Application Fee - $100 (due with application)
Tuition - $1650 (due by August 23, 2019)
TOTAL = $1750

The $100 Application fee is due when you submit your application. (If you are not accepted into the program, your application fee will be refunded. The fee will not be refunded if you are accepted into the program. Please let us know if this fee is a financial hardship.)

If you are selected for the class, $1650 Class Tuition is due by Friday, August 23, 2019. Tuition Assistance may be available (see below). Note: the application fee is considered separate and is not applied to the Class Tuition.

Please make checks payable to "San Mateo Area Leadership Program" and mail to 1700 S. El Camino Real, Suite 406, San Mateo, CA 94402 or pay online at http://leadershipprogram.net/pay-tuition/

You'll be notified of acceptance into the Program by July 1, 2019.

Payment Plan
Tuition Assistance
It is the goal of the Leadership Advisory Board to make this program as accessible as possible for those willing to step forward in their roles as community leaders. To this end, a LIMITED NUMBER of partial scholarships are available, up to 50% of tuition.
Please briefly describe your need and why tuition assistance would impact your ability to participate in the program. Applicants who receive tuition assistance will be notified before July 1, 2019.
Your answer
How much financial assistance are you requesting?
Please note that scholarship funds are limited and there is no guarantee the funds you are requesting will be available.
Your answer
Declaration upon Completion of Application *
In submitting this application, I hearby declare that:
Required
Signature of Applicant *
Typing your name here will serve as your signature.
Your answer
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