Leadership Culver City

First Name

Last Name

Email

Personal Phone

Residential Address

Work Title

Work Organization

Work Phone

Are you 18 years of age or older

Yes

No

No, but I will be in Jan 2025

Do you live or work in Culver City? (Select all that apply)

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 2025 and running through June 2025?

Yes

No

Yes, but with exceptions (explain below)

Your work experience has been in (select all that apply):

What do you hope to gain from participating in Leadership Culver City?

How would you define “Civic Engagement”?

What has been your previous or current experience in “Civic Engagement” activities?

What are the local issues that are of interest to you? (list up to three)

What areas of leadership or communication skills would you like to develop further? (list up to three)

Application Form - 2025 (CURRENTLY OPEN)