Application - Page 1 of 2

Thank you for your interest in the Washington County Civic Leaders Project.   We are collecting applications up through Dec 19th, 2017 and will notify those selected to participate by December 24th, 2017.   All information shared via this application will be treated confidentially; solely for selecting participants for this pilot.

If you are sending in a paper application, please print out the .pdf form, answer the essay questions 14, 15, and 16 on the back of the pages.  Your application can be hand delivered or mailed.  If mailed it should be postmarked by 12/16 to arrive by 12/19/17 to:  Patricia Alvarado, Adelante Mujeres, 2030 Main Street, Suite A, Forest Grove, OR 97116.   

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* 1. What is your first name?

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* 2. What is your last name(s)?

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* 3. Contact information:

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* 4. Do you live in Washington County?   Note: The project is only open to Washington County residents.

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* 5. How long have you lived in Washington County?

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* 6. What is your Country of Origin/Birth Place?

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* 7. How would you describe yourself? (select all that apply)

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* 8. What languages do you speak?

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* 9. What communities do you represent? (select all that apply)

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* 10. What industry(s) do you represent?

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* 11. What is your gender?

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* 12. What is your age?

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* 13. What is your approximate average household income?

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* 14. Why do you believe diverse representation is important to civic leadership?  (2-3 paragraphs)

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* 15. Why are you interested in this project aimed at developing civic leaders? (2-3 paragraphs)

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* 16. Tell us about your past experience in civic leadership. (2-3 paragraphs)

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* 17. Will you be available for all of the following dates and times? 

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