Class of 2019 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 7-8, 2018. (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

Deadline: Friday, May 11, 2018.

Questions? Contact Margi Power, Program Director, at (650) 401-2444 or Thank you!

Email address *
Personal Information
Full Name *
First, Middle and Last name
Personal/Cell Phone number *
Home Address
Employment and Professional Experience
Sponsoring Organization/Business (if different from your current Employer)
("Sponsoring organization" means they will cover the cost of your tuition.)
Name of Person at Sponsoring Organization
Applicants for the Leadership Program must have the support and commitment of their sponsoring business or organization, if applicable. Please indicate the full name, title and contact information for the person at the sponsoring organization, if applicable, as indication of their support for your participation in Leadership.
Business Address
Business Phone Number
Business Email Address
LinkedIn Profile
Industry Sector (check all that apply) *
Briefly describe your interest in the Leadership Program, what you hope to gain and how you expect to utilize your Leadership Program experience.
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.
Please upload a current resume (in PDF format) OR complete the sections below.
Please list your education background including degrees awarded, field of study, professional institutes, training programs, etc. Include special honors or awards.
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.
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.
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.
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.) Include First and Last Name, Email Address and Phone Number.
Tuition and Fees
Total tuition and fees for the 2019 Leadership Program are $1600.

$100 Non-Refundable Application fee is due when you submit your application.

If you are selected for the class, $1500 Class Tuition is due by Friday, August 24, 2018.

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

You'll be notified of acceptance into the Program by July 1, 2018.

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. Applicants who receive tuition assistance will be notified before July 1, 2018. Please briefly describe your need and why tuition assistance would impact your ability to participate in the program.
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.
Declaration upon Completion of Application *
In submitting this application, I hearby declare that:
Signature of Applicant *
Typing your name here will serve as your signature.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Additional Terms