Your Federal Quarterly Tax Payments are due April 15th Get Help Now >>

LSF Program Application 2013 by qKQ55N

VIEWS: 6 PAGES: 5

									Phone: (505) 204-8046

           Program Application for the Class of 2013
                   (Please complete and submit by August 31, 2012)
Thank you for your interest in Leadership Santa Fe. Leadership Santa Fe is a successful and
prestigious program designed for motivated individuals who wish to learn more about the
challenges facing Santa Fe and engage in the process of improving the community. The program
combines interactive leadership skills training with an informative civic awareness curriculum
over six weekends (Fridays and Saturdays) from October 2012 through April 2013. The class
schedule is posted on page 4.

There are many benefits to joining the Leadership Santa Fe class of 2013, including:

            Personal interaction with the top leaders of the business, government and non-
             profit community
            Unique networking opportunities with your class peers and community leaders
            High level leadership management training with a premier leadership coach that
             will enhance your effectiveness as a team leader and improve your management
             skills
            Immersion into the key policy issues affecting the city of Santa Fe, Santa Fe
             County and the state of New Mexico
            Immediate induction into the "family" of Leadership Santa Fe alumni



Name: ______________________________________________________



Mailing address:___________________________________________________________

_________________________________________________________________________


                                               1
Phone number: ______________________________



E-mail address: ________________________________________



                            BACKGROUND INFORMATION



Current occupation and name of employer: ___________________________________________

______________________________________________________________________________



Previous occupation and employer: _________________________________________________

______________________________________________________________________________



Educational experience
(secondary and post secondary achievements): ________________________________________

______________________________________________________________________________



Please list any current or previous community involvement: _____________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________



Please provide the names and phone numbers of two, non-related, references who have known
you for one year or more:

   1.) ____________________________________________ phone: _____________________



   2.) ____________________________________________ phone: _____________________

                                             2
Please provide any information about yourself and your interests that you wish to share:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________



What do you think are the most critical issues and challenges facing the Santa Fe area?:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________



How would you most like to benefit from participating in Leadership Santa Fe? What would you
like to receive from your commitment to the course?:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________




                                                3
Note: Upon acceptance into the program, your full commitment to this program is required. Your
employer must also fully support your participation even if class sessions occasionally occur on
normal work days.

Annual program tuition rates:

       $900 is the regular tuition fee

       $850 is the tuition fee for any employee of a firm that is a member of the Santa Fe
       Chamber of Commerce

       $800 is the tuition fee for anyone employed by a non-profit organization or
       government

A limited number of partial financial scholarships may be available. Please check here if you
wish to be contacted to discuss financial assistance opportunities: _______

Lunch and a continental breakfast are provided at all sessions.

By signing below, you and your employer understand and agree that if you are selected by the
Leadership Santa Fe Selection Committee your attendance at all class sessions is a requirement
for the successful completion of the program.


PRINTED NAME OF APPLICANT: _______________________________________________
DATE: ____________________

SIGNATURE OF APPLICANT: ___________________________________________________

Please return the signed form to: Program Director, Leadership Santa Fe, P.O. Box 9444,
Santa Fe, NM 87504 -or- Fax the completed form to: (866) 277-6919

You may also scan the application and email it to: info@leadershipsantafe.org

                                    CLASS SESSION DATES

October 5 – 6, 2012:            Economic Development

November 9 – 10:                Environment and Sustainability

December 7 – 8:                 Youth and Education

February 8 – 9, 2013:           Government

March 8 – 9:                    Health Care

April 12 – 13:                  Non-profit Organizations

                                                4
LEADERSHIP SANTE FE GOVERNING COMMITTEE

Chair:       Diana Ronquillo, First Citizens Bank

Vice Chair: Dr. Kevin Garrett, M.D.

             Craig Deforest, Craig G. Deforest and Associates

             Sigrid Morton, Sam’s Club

             Mariann Minana-Lovato, Museum of New Mexico Foundation

             Jillian Bartley, Los Alamos National Bank

             Rebecca Carrier, Thornburg Investment Management

             Zach DuFresne, Hutton Broadcasting

             Simon Brackley, Santa Fe Chamber of Commerce



J.D. Bullington, program director

David Markwardt, leadership skills trainer, Santa Fe Community College




                                          5

								
To top