Leadership Vacaville Application

LEADERSHIP VACAVILLE 2024-2025 APPLICATION
Contact Information
Full Name*
Name or Nickname You Prefer
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Preferred Phone*
Preferred Email*
example@example.com
Food Restrictions
Physical Restrictions
Employment
Current or Last Employer*
Position Title*
Hire Date

MonthDayYear
Date
Phone
Website
Business Address (Street, City, Zip)*
Brief Description of the Business and Your Responsibilities*
Education
Highest Level of Education*
Name and City of School
Major and Degree Achieved
Dates Attended

MonthDayYear
Date
List Any Apprentice or Certificate Programs Completed
Date Completed

MonthDayYear
Date
Reason, Intentions, & Interest
A. Number of years you have lived/worked in Vacaville?*
B. Do you expect to be living in and actively involved in the Vacaville area in five years?*

YesNoUnsure
C. What are your primary reasons for applying to Leadership Vacaville?*
D. Please list at least two thing you would like to learn or accomplish during the program that would make Leadership Vacaville successful for you and worth the time investment. Include specific business and/or personal skills you would like to develop if possible.*
E. Do you have any specific leadership goals that completing Leadership Vacaville would help you accomplish?*
F. Please list your top two to three concerns regarding our city and/or region.*
Additional Personal Information
Please share any additional information that you would like the Chamber to know about you, (background, current community involvement, activities, clubs, etc.)
Commitment & Expectations
Leadership Vacaville is a time and financial commitment. In order to complete the program, participants must understand the following:
- Classes meet on the second Thursday of the month from October to June.
- Participants are expected to set aside 8:30 am to 5:00 pm for all class sessions. Each session will consist of a variety of presentations, and most classes with include tours/field trips, and different skills development. Lunch will be provided at all class sessions. Please be prepared to change locations during the day. Transportation will generally be provided, but occasionally you will be asked to provide your own transportation or carpool.
- Although we expect students to attend all classes, all day, we understand that isn't always possible. In order to complete the program, no more than 2 missed classes or late arrival/early departures are accepted. Participants are required to complete a community assignment outside of regular class hours to make up for missing classes.
- Active participation in the Team Project is part of the Leadership Vacaville program. This will require time outside of class sessions, anywhere from 1-3 hours per month.
Tuition
- Tuition for Leadership Vacaville is $1,500 for Vacaville Chamber of Commerce members and $1900 for non-members.
- You may pay tuition in full in advance or arrange to pay half of the tuition prior to the first day of the program with the balance due by December 31.
- Alternative payment arrangements may be considered upon request.
Tuition will be paid by:*

ParticipantEmployerOther
Acknowledgement
I understand that completion of this application does not guarantee my acceptance into the program. If accepted to participate, I affirm that I am willing and able to abide by the Commitment & Expectations stated above. If for any reason I am unable to attend a session or my current situation has changed, I will contact the Vacaville Chamber of Commerce immediately.
Applicant Signature*

Clear
Date*

MonthDayYear
Date
Employer Signature*

Clear
Date*

MonthDayYear
Date
Employer Name
Phone Number
SUBMIT COMPLETED APPLICATIONS BY SEPTEMBER 1, 2024

411 Davis Street, Ste. 101 . Vacaville, CA 95688 . 707.448.6424 Connect@VacavilleChamber.com
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LEADERSHIP VACAVILLE 2024-2025 APPLICATION

Contact Information

Employment

Education

Reason, Intentions, & Interest

Additional Personal Information

Commitment & Expectations

Tuition

Acknowledgement