Leadership Program Application - Apply for the Leadership Program Application

2024-2025 Leadership Program

For any questions/concerns, please contact Amy Buckmaster at amy@chambersmc.org

Leadership Application

First Name

Last Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

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

How did you learn about our program?

Employer Name

Referral Name

Event Name

Name of Other

Employment

Currently Employed?

Yes

Business Name

Years with Employer

Industry

Type of Business

Your Job Title

Supervisors Name

Phone

Email Address

Briefly describe your role/responsibilities

Previous Employment

Business Name

Years with Employer

Industry

What type of Industry?

Type of Business

Your Job Title

Supervisors Name

Phone

Email Address

Briefly describe your role/responsibilities

Education & Training

Name of School

Degree/Certificate

Name of School

Degree/Certificate

Name of School

Degree/Certificate

Other Academic Highlights or Achievements

Organizations, Activities & 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

Date of Membership

Organization

Date of Membership

Organization

Date of Membership

Describe Your Involvement with Organizations

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/San Mateo County?

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

Clean Energy

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/San Mateo County 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/San Mateo County program is $2,000.00 and is due in full two weeks prior to the first program class in September. Credit card payment is accepted. Checks should be made out to Chamber San Mateo County.

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

Self

Employer

Other

Please include instructions where to email invoice: Name & 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.