CGL Participant Application

CGL Participant ApplicationKalee Cummings2022-03-22T18:26:37-07:00

"*" indicates required fields

Name*

First Last

Job Title*

Organization*

Work Address*

Street Address City State / Province / Region ZIP / Postal Code

Office Phone*

Office Fax

Email*

How long have you worked in Local Government?*

MMANC Member*

Yes

No

ICMA Member*

Yes

No

Leadership Academy Participant

If you are participating in a leadership academy lead by Miller Consulting, please select which leadership academy you are participating in.

Alameda County Leadership Academy

Contra Costa County Leadership Academy

Marin Sonoma Counties Leadership Academy

Sacramento Valley Leadership Academy

Describe your current responsibilities:*

Describe your organization (# of employees, annual operating budget, function or services provided):*

List your professional honors, awards, and/or volunteer activities:*

Why do you want to participate in the CGL program and how will it benefit your career growth?*

Please describe your career goals:*

Please upload your current resume:*

Max. file size: 50 MB.

Application Processing*

Your application will be submitted to the CGL Committee, for review. You will receive a response within two weeks following receipt of your application. Once accepted into the Program, you will be invoiced the $75 Participant Fee.

I certify that the information contained in this application is correct to the best of my knowledge. I understand that falsifying information is grounds for dismissal from the Program.

I understand and agree

I do not agree

Name

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

Δ

Our mission is to inspire, inform and connect local government leaders in Northern California through an engaged community.

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