APPLICATION
leadership arts
TIME COMMITMENT: Leadership Arts 2011-2012 begins on Wednesday, September 14, 2011
at noon. Following the first session, Leadership Arts will meet on the second Wednesday
afternoon of each month from 1-5 pm through April 2012. (Please note: this schedule is
subject to change.) Participants are expected to make every effort to attend all program
sessions. Attendance at six out of eight sessions is required to graduate. The total class time
based on full participation is 32 hours (8-monthly, 4-hour long sessions.)
TO APPLY: Please complete the following application and return it, a copy of your résumé,
a headshot (JPEG format only) and your $100 deposit by email to main@cbca.org, by mail
to CBCA, 130 W 12th Ave Denver, CO 80204 or by fax to 303-282-5174.
PROGRAM FEE: A $100 deposit must be sent with application. The deposit is refundable by
request only until the application deadline date but it will be refunded to any candidate not
selected for the program. The total fee is $600 for CBCA members, $850 for non-members.
DEADLINE: Applications must be received by 5 pm on the last Friday, August 26, 2011, and
candidates will be notified of their acceptance status no later than September 2, 2011.
Name (First & Last)
Title
Company/Organization
Work Address
City, State Zip
Work Phone
Cell Phone
Work Fax Phone
Work Email
Are you an employee of a CBCA member company or an individual member?
*If no, CBCA will contact you about membership options
 Yes
 No
 I don’t know
 Sign Me Up! (Download membership form)
How did you hear about Leadership Arts?
 CBCA’s mailing list
 CBCA’s website
 CBCA’s Facebook/Twitter
 Employer/Colleague
 Internet posting
 Other, please specify:
 Leadership Arts Graduate
Thanks to our generous sponsor:
Ethnicity:
*Optional
 African/African American
 Latino
 Native American
 Other
 Asian American/Pacific Islander
 Multi-Racial
 Caucasian (Not Latino)
Age:
*Optional
 Under 25
 25-35
 35-45
45-55
55-65
65+
PAYMENT: A $100 deposit is required with this application
Please choose one payment option:
 Check is on its way
 Invoice Me
 Credit Card
Credit Card Billing Information:
Name (as it appears on card)
Billing Address
City, State Zip
Billing Phone
 American Express
 Discover  MasterCard
 Visa
Card Number
Card Expiration Date
Security Code
PLEASE ANSER THE 3 FOLLOWING QUESTIONS:
1. Why do you want to participate in Leadership Arts? (max 300 words)
2. What experience/personal qualities do you bring to contribute to the group? (max 300
words)
3. What aspects of arts and cultural board leadership would you particularly like to
explore in Leadership Arts? (max 200 words)
Submit this application, a copy of your résumé, a headshot (JPEG format only)
and your $100 deposit by email to main@cbca.org, by mail to CBCA, 130 W 12th
Ave Denver, CO 80204 or by fax to 303-282-5174 by 5 pm on Friday, August 26,
2011.
Thanks to our generous sponsor: