Emerging Leaders Development Program Application Please enable JavaScript in your browser to complete this form.Name *FirstLastPlease review and check the following boxes to indicate your agreement. *I understand that my application is 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 based on "no show" behavior.I understand that by registering for a CalTrin training, I consent to be added to the CalTrin mailing list.Please review the Emerging Leaders Development Program Schedule and Attendance Policy and check BOTH of the boxes below to indicate your agreement: *To the best of my knowledge at this time, I will be able to attend all sessions in the program scheduleI understand that if I miss more than 2 sessions and/or any designated "mandatory" sessions, I will be not be allowed to complete the programContact InformationEmail *Phone *Please provide the best phone number to reach you about your application, program changes, and follow-up.Participant email addresses will be shared with an assigned accountability group to facilitate communication. Please indicate your consent to share your email address: *Share with all ELDP participantsShare with Accountability Group OnlyMy Leadership Experience and Current RoleDuring my career, I have been in leadership and/or supervisory roles for: *I am not yet in a leadership/supervisory roleLess than 1 year1-1:11 years2-2:11 years3-4:11 years5 years or moreJob 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/AgencyOrganization *In which California County do you work? *Not in CaliforniaMultiple Counties/ Statewide (California)AlamedaAlpineAmadorButteCalaverasColusaContra CostaDel NorteEl DoradoFresnoGlennHumboldtImperialInyoKernKingsLakeLassenLos AngelesMaderaMarinMariposaMendocinoMercedModocMonoMontereyNapaNevadaOrangePlacerPlumasRiversideSacramentoSan BenitoSan BernardinoSan DiegoSan FranciscoSan JoaquinSan Luis ObispoSan MateoSanta BarbaraSanta ClaraSanta CruzShastaSierraSiskiyouSolanoSonomaStanislausSutterTehamaTrinityTulareTuolumneVenturaYoloYubaTotal number of employees at your organization/agency *Describe the community/population you serve: *Program Interest and AvailabilityWhy 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, including communicating with an assigned accountability group? *YesNot at this timeComments and QuestionsAddress to Ship Training MaterialsPlease provide an address that you are able to easily access to receive program materials. This address does not need to be your office address. Please note that we can NOT ship to a PO box.Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeSupervisor InformationName of Your Direct Supervisor *FirstLastTitle (Direct Supervisor)Phone (Direct Supervisor)Email (Direct Supervisor) *Apply