Apply – Leadership Pinellas

Leadership Pinellas Application

Please complete the form below to be considered for the Leadership Pinellas program. Your information will not be saved if you leave the application window before submission. Your application fee of $50 will be collected via PayPal before your submission. Have questions? Please email [email protected]

Name*
First Last
Organization*
Position*
Work Address*
Street Address Address Line 2 City State ZIP Code
Home Address*
Street Address Address Line 2 City State ZIP Code
Cell Phone*
Work Phone*
Home Phone
Email*

What are your responsibilities with your present employment?*
What makes you unique?*
List up to five of the most significant community, civic, business or other organizations in which you have been active in the past five years. Please include positions held and time frames.*
What is your greatest responsibility, skill or career achievement to date?*
Describe your top leadership strengths.*
How did you hear about Leadership Pinellas? If an alumni referred you, please list their name.*

Applicant Personal Commitment
I understand the purpose of Leadership Pinellas and, if I am selected, I will devote the time and resources necessary to complete the program and I will abide by the Attendance and Participant Commitment Policy. I also consent to a criminal background check prior to my commencement in the program if I am selected.
Signature*
Please type your full name.
Date*
Date Format: MM slash DD slash YYYY
CAPTCHA
Your application process is not complete until you've submitted your application fee on the next screen.

The application period for the Class of 2021 is open until June 1, 2020.

Leadership Pinellas Application

Leadership Pinellas tuition is due in full by July 13, 2019

Applicant Personal Commitment

Programs