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Leadership Culver City
Application Form - 2026
First Name
*
Last Name
*
Email
*
Personal Phone
*
Residential Address
*
Work Title
Work Organization
Work Phone
Are you 18 years of age or older
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Yes
No
No, but I will be in Jan 2026
Do you live or work in Culver City? (Select all that apply)
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Yes, I live in Culver City
Yes, I work in Culver City
Neither
Are you able to attend sessions on the 3rd Friday of each month from 9 am - 4:30 pm beginning in January 2026 and running through June 2026?
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Yes
No
Yes, but with exceptions (explain below)
Tuition (Select the closest)
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I can personally cover the associated costs
I will get my employer or external source to cover the cost for me
I require assistance from LCC and their network
Other - Please contact me
Your work experience has been in (select all that apply):
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Business
Education
Government
Nonprofits
Other (explain below)
What do you hope to gain from participating in Leadership Culver City?
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How would you define “Civic Engagement”?
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What has been your previous or current experience in “Civic Engagement” activities?
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What are the local issues that are of interest to you? (list up to three)
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What areas of leadership or communication skills would you like to develop further? (list up to three)
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Submit
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