Emerging Leaders Development Program

Please review and check the following boxes to indicate your agreement. *

I have reviewed the Emerging Leaders Development Program schedule and, to the best of my knowledge, will be able to attend all required sessions.
I understand that my application in not complete until I have provided a signed Leadership Support Form.
I understand that this program will require my active participation, including using audio and webcam.
I understand that if selected for this program and I am unable to participate, I should contact CalTrin. CalTrin may deny future applications for small group training for up to 6 months based on "no show" behavior.
I understand that by registering for a CalTrin training, I am giving consent to be added to the CalTrin mailing list.

Name *

First

Last

Email *

Phone *

Please provide the best phone number to reach you about your application, program changes, and follow-up.

During my career, I have been in leadership and/or supervisory roles for: *

My Current Role

Job Title *

Number of employees you currently supervise *

If you do not currently have direct reports, the next question is REQUIRED.

If you are not currently in a role with direct reports, please describe your responsibilities:

Years in Current Role *

If less than 3 years, the next question is REQUIRED.

If less than 3 years in your current role, please list roles, length of time in each role and organization(s) for the previous 3 years.

My Organization/Agency

Organization *

If in California, what county is your agency/located in? *

Total number of employees at your organization/agency *

Describe the community/population you serve: *

Program Interest and Availability

Why have you decided to apply for the Emerging Leaders Development Program? *

What are you hoping to learn and/or gain from this leadership program? *

Please provide examples of professional development you have completed in the previous 3-5 years, either inside or outside your organization. *

Are you able to commit up to 3 hours per week for program coursework? *

Yes
Not at this time

Address to Ship Training Materials

Please provide an address that you are able to easily access to receive program materials.

Address *

Address Line 1

Address Line 2

City

State

Zip Code

I consent to share my contact information with other participants of this training (not to include mailing address). *

Yes
No

Consent to share information is requested to facilitate communication among participants during and after the program. Consent is not required to participate in this program.

Name of Your Direct Supervisor *

First

Last

Title (Direct Supervisor)

Phone (Direct Supervisor)

Email (Direct Supervisor) *

Comments and Questions

Emerging Leaders Development Program

Application

My Current Role

My Organization/Agency

Program Interest and Availability

Address to Ship Training Materials

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