WIC Leadership Academy Application

WIC Leadership Academy

Applications must be submitted by August 31, 2025. Please contact Lena Workman at lworkman@calwic.org with any questions.
Name*

First NameLast Name
Preferred Pronouns
Organization*
Job Title/Position*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Date of Birth*

MonthDayYear
Date
Language of Origin (other than English)
Languages Spoken (other than English)/Your Fluency
Your Fluency In Other Language

1

2

3

4

5

1 is Basic, 5 is Fluent
Ethnic Background*

African AmericanAsian/Pacific IslanderCaucasianLatinxNative AmericanOther
Dietary Restrictions/Allergies
Education & Training
Highest Degree You Have Earned*
Year Earned*
School*
Major Study*
Background/Work Information
Hire Date At WIC*

MonthDayYear
Date
Starting Date at Current Position*

MonthDayYear
Date
Full Time or Part Time (choose one)*

Full TimePart Time
Average Number of Hours
Direct Supervisor's Name*
Supervisor Title*
Supervisor Phone Number*
Please enter a valid phone number.
Supervisor Email*
example@example.com
Describe your major responsibilities:*
Descriptive Data
What is your confidence level in your leadership abilities/skills?*

1

2

3

4

5

6

7

8

9

10

1 is Worst, 10 is Best
Please explain why you choose the rating above*
Please identify three key leadership strengths you honed during your professional journey*
Please describe your proficiency in the skills you listed above*
What three key leadership skills are you hoping to gain through the WIC Leadership Academy*
Please describe why you chose the skills listed above*
What do you find challenging as a manager/leader?*
What do you like most about your current job?*
What do you like least about your current job?*
Name a leader that you would like to emulate and what is it about them that you admire? *
Upload Supervisor Form and Picture
Upload Completed Supervisor Form*

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Upload Picture*

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Commitments
As an applicant for the WIC Leadership Academy, I am willing and able to make the following commitments if accepted:

1. I will commit the time necessary to all WIC Leadership Academy activities.
2. I will complete all pre-work and homework assignments.
3. I will be an active contributor to the program.
4. I will attend all sessions comprising the program.
5. I will participate in the evaluation activities of the program.
Signature*

Clear
I hereby certify that all the information provided in this application is true and correct.
Should be Empty:

WIC Leadership Academy

Education & Training

Background/Work Information

Descriptive Data

Upload Supervisor Form and Picture

Commitments