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 Dec 2026

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 December 2026 and running through June 2027?

Yes

No

Yes, but with exceptions (explain below)

Tuition (Select the closest)

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

There are a limited number of $300 scholarships available for those with financial hardships. Also, tuition may be paid in two installments

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 - 2027