Leadership Burbank 2022-2023 Application

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Thank you for your interest in applying for the Leadership Burbank Class of 2022-2023. All applications are due on Friday, July 22nd. The Class will be announced on Friday, August 5th with an Orientation scheduled for August 24, 2022.

Please review each section prior to submission as you will not have a chance to resubmit your answers.

After your application is submitted, please email a professional photo that you will give Leadership Burbank permission to use for the Program. Email your professional photo to admin@LeadershipBurbank.org

Personal Contact Information *

First and last name

Home Address *

Home Email Address *

Home Phone number (Mobile) *

Business Address *

Business Phone Number *

Business Email Address *

I prefer communication be sent to my *

Home Email Address

Business Email Address

Employment History (List your current and previous 2 employment positions, including the name of the Organization, the Position Title, the Dates of Employment, and the Supervisor Name and a Contact Phone Number) *

Education (Listing your current or most recent first, please list your Education History, including the school name, the Major/Minor, Degree, and Date of Graduation) *

Civic/Community Activities: Listing your current or most recent first, please list any civic or community activities or volunteerism, including the name of the organization, any positions you have fulfilled, the dates of your involvement, and a website, if applicable. *

Community Interests: List your top three community interests from this list: Arts/Culture, Small or Large Business, Economic Development, Education, Energy/Water, Environment, Law Enforcement, Emergency Response, Government, Health Care, Housing, Land Use, Social Justice, Social Services, Transportation, Workforce Development, Youth Services. *

Do you have an additional community interest that was not on that list? If so, please list it here:

Honors or Recognitions (Please list most recent first or write N/A if not applicable) *

References (Please list two references (personal or professional) that we may consult regarding your application) *

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