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2012 Leadership Portland Application

To apply for the 2012-13 Leadership Portland program, candidates must submit an application and two letters of recommendation; one from their employer and one from a community leader by Friday, April 27, 2012.

You must fully complete each section. Essay questions should be limited to 150 words. Compose each of the required essays using a word processing program in case you experience technical difficulties while submitting the form. This will also provide you with a copy of your application for your records.

Personal Information
First Name:
Last Name:
Preferred Name:
Home address:
City, State, Zip:
Cell phone:
Home email:
Emergency contact: (name & phone number)
Length of residence in the Portland region:
Place of residence prior to living in the Portland region:
Hobbies:
Employer Information
Company/Organization Name:
Type of business:	For profit Non profit Government Higher education
Brief description of the company:
Business address:
City, State, Zip:
Applicant's Position Title:
Date of Hire:
Business Phone:
Business Fax:
Business email:
Tuition Billing Information: Please provide contact information for the company or individual who will pay your tuition.
Tuition Sponsor:
Billing Address:
City, State, Zip:
Education:
Highest level of education:	High School Some College Under-Graduate Post-Graduate
School Name/Degree:
Academic Achievement, Community or Professional Awards:
Leadership positions held or organizational involvement:
1. Your Leadership Skills: Give one example of your greatest professional achievement. Please describe the achievement, your role in the effort, leadership qualities you demonstrated, how the effort affected the community and any personal reflections you would like to share.
2. Commitment to the Community: Describe your involvement in current or past civic activities and what motivated you to become involved. How much time do you currently devote to volunteer work?
3. Interest in Leadership Portland What do you hope to accomplish through participation in Leadership Portland? Please include how you see yourself contributing to the community in the future.
4. Other You have had an opportunity to answer a number of specific questions about yourself. Given that the mission of Leadership Portland is to develop community leaders, what else do you believe we should know about you as a candidate for this program? You may either add to something you have already said, or provide additional information you believe to be relevant to your candidacy.
5. Diversity (optional): In order to select a class that is representative of the diversity in our community, we encourage you to provide the following information:
Gender:	Male Female
Age:	20-29 30-39 40-49 50-59 Over 60
Ethnic/Cultural Indentification:	Caucasian African American Hispanic Asian Native American Eskimo/Pacific Islander
Other:
Disability or Special Needs:	Yes No
If yes, please indicate what assistance is required:
I have read the requirements for participation, agree to meet all the requirements as stated and have cleared participation with my employer.
Please type the above letters for verification purposes. Please click submit only one time.  The transaction may take several seconds.