2015/2016
LEADERSHIP ARVADA APPLICATION
Name_________________________________________________________________________
Name as preferred on badge_______________________________________________________
Employer_____________________________________________ Years with employer ______
Title_________________________________ Work phone_____________________________
Address_______________________________________________________________________
City________________________________________
Zip________________________
Email_________________________________________________________________________
Home Address__________________________________________________________________
Zip_________________ Phone___________________________
This program is sponsored by:
Tell us about yourself. Please attach a Word document if additional space is needed.
1.Why are you interested in this program?
2. List any civic, business or professional activities in which you have participated. Include
any awards, or special recognition or offices you have held. (service organizations, trade
groups, volunteer activities, etc)
3. What experiences or areas of professional development do you hope to take away from this
program?
5.If selected for the program, what special skills to you bring to the group?
Please note the following:
1.)
Tuition is $450 and is non-refundable. This cost covers meals, materials, speaker costs,
and graduation ceremony. Plus special project cost sharing (not to exceed $50/person). If
excepted into the program, tuition is due August 31st and payable to: Arvada Chamber of
Commerce.
2.)
Applicants for Leadership Arvada, if employed, must have the support and commitment of
their employer. The employer must authorize participation in the program.
___________________________________________________
(Employer’s Signature)
__________________
(Date)
3.)
If selected to participate in Leadership Arvada, you must commit to attendance for the full
time allocated for that day’s presentation(s).
4.)
No more than two excused absences are permitted to participate in graduation.
5.)
Extra time will be required for your class project which will be scheduled outside of
Leadership Arvada class time. You and your classmates will identify a project and
determine related costs (if any).
6.)
No substitutions are permitted for attendees.
7.)
Employers will be invited to participate in the graduation ceremony. Additional guests may
result in additional costs to the participant.
8.)
Because of logistics and program design, the program is limited to 25 participants.
Applications will be reviewed by the selection committee.
If selected to participate in Leadership Arvada, I agree to all the terms and conditions of the program.
_____________________________________________________
(Applicant Signature)
__________________
(Date)
Please return this application to: Arvada Chamber of Commerce, 7305 Grandview Ave Arvada
CO 80002 or email to lynn@arvadachamber.org.