Leadership: Cape Cod
The Community Leadership Institute
Program Application
Print this form, complete the information, and send it noted on the bottom of the form.
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PERSONAL DATA |
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PLEASE TYPE |
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Name: ____________________________ |
Nickname: ___________________ |
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Home |
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Business |
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Home Phone _______________________ |
E-mail _____________________________ |
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Business Phone ______________________ |
Fax: _______________________________ |
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Business Sponsor: Do you have a sponsor, e.g. employer, etc.? Yes _____ No _______ |
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Number of years that you have lived and/or worked on Cape Cod ___________ |
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Education. Please include trade schools and other specialized training and/or education._________________________________________________________ _________________________________________________________ |
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Professional/Personal Achievement. (What do you consider your highest responsiblity, skill or career achievement to date?)_________________________________________________________ _________________________________________________________ |
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Volunteer Service. (If you are already working in community service activities, what are you doing at the present time?)_________________________________________________________ _________________________________________________________ |
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Future Volunteer Activity . (The focus of Leadership: Cape Cod is to expand interest and leadership in Cape Cod activities. Will you expand or redirect your volunteer activity upon completion of this course? Yes ____ No ____. If you had the opportunity, in what community service activities would you like to be involved?)_________________________________________________________ _________________________________________________________ |
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Expectations. (Please be specific as to why you are interested in this program.)_________________________________________________________ _________________________________________________________ |
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How did you hear about this program? ___________________________ |
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Please print this form on your computer's printer, complete it and return to:
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COMMUNITY LEADERSHIP INSTITUTE |
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