Application Fee - $10 (Non-Refundable) All Applications will be handled in the strictest confidence. Please limit responses to the space provided. Participants will be selected from those individuals who have submitted their Application Form by MARCH 31ST. Spouses cannot participate in the same program year. Please write legibly or type. Name (Last)_______________________ (First)_________________(Nickname)______________ Mailing Address____________________________________________________________________ Home Phone________________Email________________________________Years in Area ______ Have you ever applied for Leadership Redding before?_______________________________ How did you hear about Leadership Redding?_________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ EMPLOYMENT Present Employer______________________________________ Date Began__________________ Business Address __________________________________________________________________ Job Title_________________________ Business Phone__________________________________ Briefly describe your areas of responsibility______________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ Previous employment in the last five years. EMPLOYER TITLE OR RESPONSIBILITY FROM-TO __________________________________ ________________________________ _______________ __________________________________ ________________________________ _______________ __________________________________ ________________________________ _______________ Briefly outline major accomplishments of your employment background________________ ___________________________________________________________________________________ ___________________________________________________________________________________ What are your career objectives?___________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ EDUCATIONAL BACKGROUND SCHOOL/COLLEGE DEGREE EARNED FIELD OF STUDY ___________________________________ _____________________________ _________________ ___________________________________ _____________________________ _________________ ___________________________________ _____________________________ _________________ ___________________________________ _____________________________ _________________ Please list other community, civic, professional, business, religious, social, athletic, or other organizations of which you have been a member. ORGANIZATION/ACTIVIITES DATES OF MEMBERSHIP OFFICIAL POSITIONS HELD ____________________________________ ______________________ _______________________ ____________________________________ ______________________ _______________________ ____________________________________ ______________________ _______________________ ____________________________________ ______________________ _______________________ What do you consider your most significant accomplishment/activity in connection with these organizations? _________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ What would you hope to gain, and how would you expect to utilize your Leadership Redding experience? (i.e. PTA, youth related, church, public office, etc.)_________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ What are your objectives or aspirations as a future community leader for the Redding region in general?_________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ In your judgement, what are the two most pressing problems facing the Redding region today? Explain why and give any recommendations you may have for approaching and resolving these problems.______________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ List two persons who have knowledge of your qualifications and background, who may be contacted by the Leadership Redding Selection Committee. Full Name & Title Present business or home address Phone Number _____________________________ __________________________________ __________________ _____________________________ __________________________________ __________________ STATEMENT OF UNDERSTANDING PARTICIPATION: In order to accomplish the program's objectives, the full partici- pation of each individual selected is necessary. Participation includes the equivalent of one full day approximately once a month, excluding the Weekend Workshop, from September through June. There are some optional class electives. TUITION: Tuition for each participant is $650.00. A non-refundable deposit of $125.00 is payable by July 15th. The balance of the tuition is due August 15th. A limited amount of financial assistance may be available. If selected to participate, will you find it necessary to seek such assistance? ___________Yes__________No I understand the purpose of Leadership Redding and acknowledge completion of this application does not ensure a candidate's acceptance. Attendance at the Weekend Workshop is mandatory. If selected, I agree to commit the time and energy required. Applicant's Signature___________________________________________ Date______________ Applicants must have the support of their employer. Attendance at each session is required. I understand the importance of participation and this applicant has my full support for the time and personal commitment required for effective participation in the Leadership Redding experience. Date_______________________________________________ Signature of Employer______________________________ Title__________________________ Company Name_______________________________________________________________________ Address____________________________________________________________________________ Mail or deliver with a $10.00 application fee to: Leadership Redding Shasta Regional Community Foundation 1335 Arboretum Drive, Suite B Redding, CA 96003 (530) 244-1219 DEADLINE DATE: MARCH 31ST