Name(Required)

Preferred Pronouns First Last Suffix (e.x. Ph.D., Ed.D)

Preferred Name(Required)

Please write your full name, as you prefer to be addressed. Will be used on name tags, correspondence, etc.

Contact Email(Required)

Please share your preferred email account that will be used for all VCLA communicaton.

Preferred Social Media Profile(Required)

Please provide a LINK to your preferred, personal social media profile.

Cell Phone(Required)

Home Address(Required)

Street Address City State ZIP Code

Personal Email (if different than contact email)

Length of Residence in Ventura County(Required)

Do you expect to be living/working in this area in 5 years?(Required)

Ethnicity/Ethnicities with which you identify (optional):

What person referred you or how did you learn about VCLA?

Current Employer(Required)

If not currently employed, state reason (retired, student, job-hunting, etc.) and use N/A for remaining answers

Job Title(Required)

Start Date of Employment(Required)

Type of Business or Organization:

Work Address

Street Address Address Line 2 City State ZIP Code

Work Email

Work Phone

Supervisor's Name

Why VCLA?

What attracted you to the VCLA program?(Required)

Identify two significant problems facing Ventura County today that impact you or those you care about directly and would like to help solve.(Required)

Describe two concrete goals for your time with the cohort, should you be chosen to participate.(Required)

What personal attributes do you think you might contribute to the cohort as a member?(Required)

What improvements in yourself would you like to see by the end of the VCLA leadership cohort?(Required)

Other Leadership/Personal Development Programs

Please list any city, county, regional, or statewide leadership/personal development program(s) you have participated in, related to either your career, an educational institution, or your community involvement.

Community Engagement

In order of importance to you, list the top three (3) community, civic, professional, business, religious, social, athletic and/or other organizations of which you have participated in that you were most passionate about and were the most impactful to you or the community. Briefly describe the nature of your participation, responsibilities, and accomplishments.

Organization A:

Name of Organization

Dates

Purpose of Organization

Description of Participation

Organization B

Name of Organization

Dates

Purpose of Organization

Description of Participation

Organization C

Name of Organization

Dates

Purpose of Organization

Description of Participation

Employment History

Provide a brief description of your past employment (omitting your current employer information that was listed previously), including managerial and supervisory responsibilities, going back for up to 15 years. If you have been employed by your current employer over 15 years, skip this section.

Previous Employer - A

Employer

Dates of Employment

Title or Responsibility

Description

Concisely describe 2-3 primary accomplishments or meaningful experiences in this position: what you did and what impact it had on others and yourself. (1,000 character max)

Previous Employer - B

Employer

Dates of Employment

Title or Responsibility

Description

Concisely describe 2-3 primary accomplishments or meaningful experiences in this position: what you did and what impact it had on others and yourself. (1,000 character max)

Previous Employer - C

Name of Employer

Dates of Employment

Title or Responsibility

Description

Concisely describe 2-3 primary accomplishments or meaningful experiences in this position: what you did and what impact it had on others and yourself. (1,000 character max)

Education

Please provide information about your education and/or professional training. You may include "life skills" type of training in this section.

Institution or Organization 1

Institution or Organization Name 1

Major (or focus of study)

Institution or Organization 2

Institution or Organization Name 2

Major (or focus of study)

Institution or Organization 3

Institution or Organization Name 3

Major (or focus of study)

Program Requirements

Participants may miss no more than two sessions in order to graduate. Please discuss this application with your employer, supervisor, and/or family to ensure that you will have sufficient time to participate in the program and fulfill the necessary requirements to graduate.

I have reviewed the program schedule and can identify nothing at this time that will interfere with the program requirements and participation in the sessions.(Required)

Yes

No (discribe below)

Possible/known conflicts

I have discussed the VCLA commitments with my employer and/or family and they support my full participation in this program(Required)

Yes

No

Tuition is $2,250 per participant. If accepted, you will be required to pay a deposit of $250 within 14 days of acceptance into VCLA. Full payment of tuition is due before the first session. Based on financial need, payment plans and/or scholarships are available through our Tuition Assistance Program (T.A.P.) after acceptance into the program and via a separate application and deadline.

How will your tuition be paid?(Required)

This information will not be shared during the interview process and is only asked so that the VCLA scholorship application can be sent to complete once a person is accepted into the program.

Comments

This field is for validation purposes and should be left unchanged.

Apply

Apply for Ventura County Leadership Academy

We are now accepting applications for cohort XXX, beginning in September of 2024.

Application Instructions

APPLICATION FOR VCLA LEADERSHIP PROGRAM - Cohort XXX (2024-25)

Why VCLA?

Community Engagement

Organization A:

Organization B

Organization C

Employment History

Previous Employer - A

Previous Employer - B

Previous Employer - C

Education

Institution or Organization 1

Institution or Organization 2

Institution or Organization 3

Program Requirements

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