Leadership Rancho Cordova Program Application

Sponsor Information
Are you being sponsored by a company or organization?*

YesNo
Sponsoring Company/Organization
Address of Sponsor

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor at Sponsoring Company

First NameLast Name
Sponsoring Company Telephone Number

Area CodePhone Number
Is your sponsoring company nonprofit?

YesNo

Education
Please list your educational background including degrees awarded and date awarded; field of study, professional institutes, training programs, etc. *
List all honors, awards, accomplishments you received. Which do you consider the most important and why?*

Professional Background
Present Employer
Title
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business E-mail
Business Industry
Provide a summary of your job responsibilities and a description of the company/organization for which you work.
List past three (3) employers, length of employment and summary of responsibilities. *
Briefly state your long-term career goals and objectives. *

References

List three people who have knowledge of your qualifications or have previously participated in Leadership Rancho Cordova. (Note: the selection committee may contact these individuals.)
Name (reference 1)*

First NameLast Name
E-mail*
Phone Number*

Area CodePhone Number
Name (reference 2)*

First NameLast Name
E-mail*
Phone Number*

Area CodePhone Number
Name (reference 3)*

First NameLast Name
E-mail*
Phone Number*

Area CodePhone Number

Community Service and Involvement
Provide a list of the organizations in which you are a current or former member in the order of importance to you. Include the name of the organization, dates of membership, and positions held. How much time per month do you currently contribute to volunteer activities?*
What would you consider to be your most important accomplishment(s) or contribution to one of the organizations you listed?*
With what other organization or volunteers activities do you see yourself engaged in the future?*

Program Commitment
Attendance

The two-day opening retreat for Leadership Rancho Cordova is mandatory. Both days will take place at Courtyard Inn and Suites in Grass Valley. Participants are expected to attend each of the eight full-day modules and participate in a community service project with other class members. This will require time outside of class. We ask that you contact our Program Manager for the most up-to-date information. Dawn@VisitRanchoCordova.com or 916-460-8207.

For Leadership Rancho Cordova to accomplish its stated goals, participation is required. If you cannot make that commitment, it is in your best interest not to apply at this time.

Failure to attend the opening retreat will result in termination from the program with no tuition refund. If you miss more than two modules during the program, you may not be allowed to graduate.

Opening Retreat Dates:

Friday, October 4, 2024
9:00 a.m. to 5:00 p.m., with dinner to follow

Saturday, October 5, 2024
8:00 a.m. to 2:00 p.m.

Important Dates:
Friday, August 16, 2024 ~ Application Deadline
Thursday, September 19, 2024, 5:30-7:00 p.m. ~ Program Reception

Thursday, September 19, 2024 ~ Tuition Payment Deadline

Module Dates
* Curriculum topics may include the following:

Thursday, November 14, 2024 ~ Building Strong Communities/Education

Thursday, December 12, 2024 ~ History/Local Government

Thursday, January 9, 2025 ~ Current Events Module

Thursday, February 13, 2025 ~ Leadership

Thursday, March 13, 2025 ~ Recreation and Tourism

Thursday, April 10, 2025 ~ Economic and Community Development

Thursday, May 8, 2025 ~ Public Safety

Thursday, June 12, 2025 ~ Wrap-Up Module & Graduation

*Module topics and order are subject to change
Check this box if you have fully read the program commitment *

I have read and AGREE with the required attendance policyI have read and DISAGREE with the required attendance policy

Photo Release
I hereby grant the Rancho Cordova Area Chamber of Commerce & Foundation permission to use my likeness in a photograph or video in all of its publications, including website entries, without payment or any other consideration.

I understand and agree that these materials are the property of the Rancho Cordova Area Chamber of Commerce & Foundation and will not be returned.

I hereby irrevocably authorize the Rancho Cordova Area Chamber of Commerce & Foundation to edit, alter, copy, exhibit, publish, or distribute this photo for purposes of publicizing the Leadership Rancho Cordova program or for any other lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph.

I hereby hold harmless and release and forever discharge the Rancho Cordova Area Chamber of Commerce & Foundation from all claims, demands, and causes of actions which I, my heirs, representatives, executors, administrators, or any persons acting on my behalf of my estate have or may have a reason of this authorization.

I am 21 years of age or older and am competent to contract in my own name. I have read this release before signing below, and I fully understand the contents, meaning, and impact of this release.
Applicant Signature*
Typing your name above acts as a signature.
Date*

MonthDayYear

Tuition & Signatures
Date

MonthDayYear
Tuition for Leadership Rancho Cordova is $1,200. The full tuition amount is due by Friday, September 19, 2024, unless prior arrangements have been made.

Please make your check payable to Rancho Cordova Chamber Foundation (RCCF). Major credit cards are accepted.

Refund Policy
Withdrawal from the program following confirmation to participate will result in forfeiture of tuition unless an alternate is confirmed prior to the retreat.

Sponsor Commitment
Leadership Rancho Cordova nominees must have the support and commitment of their sponsoring business or organization. The signature of the head of the sponsoring organization is necessary as an indication of that support.
Sponsor Signature
Typing the name is acceptable. Sponsor may be contacted to confirm participation.
Acknowledgment

I understand that completion of this application does not ensure my acceptance into the Leadership Rancho Cordova program. I further understand that, if accepted, I will be required to fulfill the commitment requirements listed above. I also acknowledge that I have the full support of my employer to complete the program as described in this application.
Applicant Signature *
Typing your name above acts as a signature.
Date*

MonthDayYear
Application Deadline: Friday, August 16, 2024 by 5:00 PM

Submit by mail:
Leadership Rancho Cordova
Attention: Dawn S Hall
2729 Prospect Park Drive, Suite 117
Rancho Cordova, CA 95670

By email:
Dawn@VisitRanchoCordova.com

Leadership Rancho Cordova is a project of the Rancho Cordova Chamber of Commerce Foundation and the focus is on the City of Rancho Cordova. For this reason, applicants who live or work within the City of Rancho Cordova are given preference by the selection committee.

For additional information please contact Program Manager, Dawn S Hall Dawn@VisitRanchoCordova.com or 916-460-8207
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Leadership Rancho Cordova Participant Application

Personal Information

General Information

Sponsor Information

Education

Professional Background

References

Community Service and Involvement

Program Commitment

Photo Release

Tuition & Signatures