Thank you for your interest in The Leadership Connection (TLC) – a board training seminar series sponsored by The Jericho Road Project and collaborating Jericho Road sites. Please note that the information requested on this form is critical to our training. portions of the information will be included in the program binder for the class.

Applications must be received at least 2 weeks before the start of the program.

Note: There is no mechanism in the system for you to save a partially completed form for a later date, please fill out the entire application in one sitting. Thanks!

* 1. I would like to attend the following TLC seminar series. (Additional dates and locations will be posted soon)

* 2. Last Name, First Name

* 3. Company

* 4. Please give a short description of your company to include with the program notes

* 5. Job TItle

* 6. Email

* 7. Alternate Email

* 8. Day Time Phone

* 9. Cell Phone

* 10. Office Assistant Contact Name, Email, Phone

* 11. Home address

* 12. City, State, Zip Code

* 13. Skills Inventory: Upon successful completion of the training, Jericho Road staff will work to match program participants with a great nonprofit organization. Please complete the following skills inventory to enable us to make the best possible match for you.

In what areas do you consider your skills and abilities to be strongest? (Please check all that apply)

* 14. Employment: What do you consider to be your most important career achievement?

* 15. Community, Volunteer and Leadership Activities: Please list the name, position/title and responsibilities of any community and volunteer organizations with which you have been involved.

* 16. How do you hope to benefit from being on a nonprofit board?

* 17. What do you think you can contribute to a nonprofit organization?

* 18. If you have board experience already, what information or skills would help you be a more effective board member?

* 19. Please check all of the areas of interest for nonprofit service you may have.

* 20. Leadership Qualities
Growing as a leader and person is an ongoing process. Experiential learning – including board service – has helped TLC alumni grow in different and tangible ways.

Please consider selecting up to three leadership attributes that you hope to enhance through board service. Doing this before participating in TLC may help you be more deliberate about this "return" from your board experience, and will give us a baseline for our future conversations with you about being on a board!

* 21. Your Commitment

By checking each of the following statements and submitting this electronic application, I am certifying that I: