Class of 2019 Application Form

General Information

Selection into the program is based upon having a cohort that is somewhat balanced in terms of  
professions, agencies/businesses, and community sectors;  submission of this application does not guarantee acceptance into the current class.

By completing and signing this application, participants agree to the following:

1.  To notify the program director in advance of an absence and that one absence is allowed. This
     absence may be made up during the following year's training program with approval of the
     program director.

2.  If absent, the participant will contact the program director or a fellow class member to obtain
     information shared at the missed training day.

3.  By signing this application, participants agree to meet the time and program requirements, which      include confidentiality of any personal or professional information shared during the program.

Applications

Applications can be submitted online or mailed to LEB at:

          LEB - 1442 A Walnut Street, #438 - Berkeley, CA 94709

If submitted online, completion of the signature lines by employer and employee constitutes a valid agreement with LEB.  

Tuition & payment

Cost is $1,500/participant. Tuition includes retreat, class materials, continental breakfasts and lunches, and snacks on LEB Friday training days.

The program director will invoice the participant or his/her designated agency staff person upon acceptance into the program.

Tuition checks should include a notation with the name of the participant, the agency/business, and memo line notation of "for LEB program" and mailed directly to Leadership East Bay at:

         LEB - 1442 A Walnut Street, #438 - Berkeley, CA 94709

 

Download the application as a PDF


Name *
Name
Phone
Phone
Name 1
Name 1
Address
Address
Employer Name & Title
Employer Name & Title