2013 2014 Leadership Arts Application by E5QmJ3cc

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									APPLICATION
leadership arts
TIME COMMITMENT: Leadership Arts 2013-2014 begins on Wednesday, September 11, 2013 at
noon. Following the first session, Leadership Arts will meet on the second Wednesday afternoon of
each month from 1-5 pm through April 2014. (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. Applications may
also be accepted 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 $800 for CBCA members, $1,000 for non-members. If three
or more employees from company enroll, the fee drops to $650 per person for member companies
and $850 for non-member companies.

DEADLINE: Applications must be received by 5 pm on the second to last Friday, August 23, 2013,
and candidates will be notified of their acceptance status no later than Friday, August 30, 2013.

      Name (First & Last)
                      Title
   Company/Organization
           Work Address
      Work 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                 Leadership Arts Graduate          Internet posting

 Other, please specify:



                     Thanks to our generous sponsors:
Ethnicity:
*Optional
 African/African American                       Asian American/Pacific Islander
 Latino                                         Multi-Racial
 Native American                                Caucasian (Not Latino)
 Other

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 5 pm on Friday, August
23, 2013.




                    Thanks to our generous sponsors:

								
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