Class of 2019 Application Form

General Information

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

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.  Participants agree to meet the time and program requirements, which include confidentiality of any personal or professional information shared during the program.

Applications

Applications may 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 as an e-signature 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 be made out to Social Good Fund (our fiscal sponsor) and include a notation with the name of the participant and memo line notation of "for LEB program" and addressed 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