Application – Leadership Cape Cod

Name*

First Last

Preferred Name

First Last

This will be printed on your class name badge

Formal Name

First Last

This will be printed on your program certificate at completion of course

Phone (Home)*

If you only have a cell phone, please populate here as well.

Phone (Cell)*

PERSONAL Email*

Please put your personal email here and not a professional/work one, whichever home email address you use the most

Home Address*

Street Address Address Line 2 City State ZIP Code

Are you currently employed?*

Yes
No

Business Information

Business Name

Business Sector

Job Title

Job Title Category

Job Function

Business Website

Business Address

Street Address Address Line 2 City State ZIP Code

Education

Please include trade schools and other specialized training and/or education.

Connection to Cape Cod: Years Worked/Lived On Cape Cod*

Years Working on Cape?

Years Living on Cape?

Program Interest*

Why do you want to participate in the Community Leadership Institute?

How did you hear about this program?*

Professional/Personal Achievements*

What do you consider your highest responsibility, skill or career achievement?

Volunteer Service*

What community service activities are you participating in?

Do you expect to expand or redirect your volunteer activity upon completion of this course?*

Please Explain

How do you anticipate that your participation will benefit your community, organization, or work?*

Professional Reference(s)

Please include their full name, phone, email and your relationship.

Are you available to attend every session?*

Yes
No

If no, please explain

A short bio about you*

This should be a two or three paragraph thumbnail sketch of yourself. It should include your name, job title, the length of time you have been on Cape Cod, general information about your employment responsibilities and involvement in local organizations, as well as highlights of your professional, educational and personal experience. Aim for about 180 words (200 maximum).

In the future, are you interested in joining any other Leadership Cape Cod programs, events or committees? Please select all that apply:

CAPTCHA

CLI Application

info@leadershipcapecod.org
(508) 651-6626

Leadership Cape Cod
PO Box 814, Hyannis, MA 02601

CLI Application

info@leadershipcapecod.org(508) 651-6626

Leadership Cape Cod PO Box 814, Hyannis, MA 02601

info@leadershipcapecod.org
(508) 651-6626

Leadership Cape Cod
PO Box 814, Hyannis, MA 02601