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HOME
ABOUT
MISSION
BOARD OF DIRECTORS
BOARD NOMINATION FORM
CALL FOR NOMINATIONS
GET INVOLVED
CORNERSTONE MEMBERS
LIFETIME MEMBERS
CONTACT
LEADERSHIP BROWARD CLASS XLI
LEADERSHIP BROWARD CLASS XL
LEADERSHIP BROWARD CLASS XXXIX
LEADERSHIP INSIGHTS
TEAM
NEWS
EYE ON SOUTH FLORIDA
PRIVACY
PROGRAMS
FOLLOW THE LEADER IN YOU
LEADERSHIP BROWARD
LB EXPERIENCE
LB APPLICATION PROCESS
LB CLASS XLII APPLICATION
LB CLASS XLII CALENDAR
LB CLASS XLII COMMUNITY PROJECT
YOUTH LEADERSHIP BROWARD
YLB APPLICATION PROCESS
YLB CLASS XXXVII APPLICATION
YLB CLASS XXXVII CALENDAR
WOMEN LEADING BROWARD
WLB APPLICATION
EVENTS
MEN OF STYLE
SOCIALLY GOOD
TURKEY TROT
TURKEY TROT VOLUNTEER
FUN LUNCH
SERVING UP LEADERSHIP
PAST EVENT PHOTOS
PAST SOCIALLY GOODS
MEMBER BENEFITS
MY ACCOUNT
THE PEOPLE BOOK
MEMBER CENTER
MEMBERSHIP LEVELS
PAY MEMBERSHIP DUES
LIFETIME MEMBERS
APPLY FOR LEADERSHIP BROWARD CLASS 42
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24
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2
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Nov
13
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Nov
23
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Nov
30
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MEN OF STYLE
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LEADERSHIP BROWARD NEWS
Igniting Change Through Community Projects with Leadership Broward: A Legacy of Inspiration and Impact
Leadership Broward’s Community Projects: A
Leadership Broward Names New Board Chair and Board of Directors for 2023-2024
FORT LAUDERDALE, FL – Gregg Goldstein, Owner &
Leadership Broward Class XLI
The Leadership Broward Board of Directors and Alumni
Leadership Broward Names New Board Chair and Board of Directors for 2022-2023
FORT LAUDERDALE, FL – Kim Vassar, Chief Advancement
FUN LUNCH PHOTOS
LEADERSHIP BROWARD CLASS XXXVIII
Follow The Leader in You
https://www.youtube.com/watch?v=rRjOCjqtf8A&t=6s
LB APPLICATION CLASS XLII
Name
*
First
Middle Initial
Last
Cell Phone
*
Email
*
Home Address
*
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Length of Residence in South Florida area
*
Date of Birth
*
MM slash DD slash YYYY
Your Gender
*
Female
Male
Persons with a disability?
*
Yes
No
Ethnicity
*
American Indian or Alaska Native
Asian
Black or African American
Caribbean American
Hispanic or Latino
White
Full name to be listed on name tag
Are you a previous applicant for the Leadership Broward program?
*
Yes
No
Preferred Mailing Address
*
Home
Business
Preferred Phone Number Listing in Members Only Directory
*
Cell
Office
EMPLOYMENT
Please list current employment and attach resume below (optional).
Current Employer
*
Title
*
Length of Time with Employer (Years/Months)
*
Address of Employer
*
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Business Phone
*
Business Email
*
In which sector do you work?
*
For-profit
Government
Nonprofiit
Which best describes your type of business? (Your answer is for internal reporting purposes only and will not affect the strength of your application)
*
Financial
Health Services
Legal
Local Government
Marketing
Nonprofit
Public Relations
Number of Employees
More than 250 employees
50 – 250 employees
Less than 50 employees
Previous Employment or Attach Resume Below
Upload Resume (Optional)
Drop files here or
Select files
Max. file size: 50 MB, Max. files: 3.
EDUCATION
School/University (if none, type N/A)
*
School/University City
School/University State
Highest Degree Level Pursued
Associates
Bachelors
Masters
Doctorate
Major (and minor if applicable)
Graduated?
Yes
No
Dates of Education
*
(Month/Year to Month/Year)
Other School/University Information
PROFESSIONAL AND OCCUPATIONAL ACTIVITIES
Organization Name
*
Organization Dates of Participation
*
(Month/Year to Month/Year)
Position Held
*
Responsibilities
Organization Name 2
Organization Dates of Participation 2
(Month/Year to Month/Year)
Position Held
Responsibilities
Other Professional and Occupational Activies
VOLUNTARY COMMUNITY ACTIVITIES
List the key non-professional activities (charity, religious, school involvement, task forces or commissions) in which you have actively participated in the last 3 years.
Volunteer Organization
*
Volunteer Dates of Participation
(Month/Year to Month/Year)
Position Held
Responsibilities
Volunteer Organization 2
Volunteer Dates of Participation 2
(Month/Year to Month/Year)
Position Held
Responsibilities
Other activities
In an average month, approximately how many hours do you spend on voluntary community activities?
*
SPECIAL HONORS/AWARDS
List any professional or community honors or awards you have received
ESSAYS
Please answer in the space provided limiting each response to 100 words or less. No attachments please.
What do you consider to be your most significant professional or community contribution?
*
What do you consider the most significant issue facing Broward County today?
*
Why should you be selected for the Leadership Broward Class?
*
REFERENCE FORMS
The applicant must include two completed Reference Forms from different people. This form is available on the application page of the LB website. If you do not have the completed forms available right now, you can submit your application today and email the forms by the 6/12/23 application deadline to apply@leadershipbroward.org.
Upload 2 References Forms
Drop files here or
Select files
Max. file size: 50 MB, Max. files: 3.
EMPLOYER CONSENT FORMS
Applicants must have the support of their employer. This form is available on the application page of the LB website. If you are self-employed or you are the CEO/ED/President, there is no need for the consent form. If you do not have the completed form available right now, you can submit your application today and email the form by the 6/12/23 application deadline to apply@leadershipbroward.org.
Signed Employer Consent Form
Drop files here or
Select files
Max. file size: 50 MB, Max. files: 2.
TUITION
If accepted into the Leadership Broward Class XLII, you and/or your employer will be invoiced for a tuition fee of $3,000. In order to hold your seat in the class, you and/or your employer must submit payment no later than 5:00 p.m., Friday, August 4, 2023.
Will your employer be responsible for your tuition?
*
Yes
No
A portion
Will a sponsor be responsible for your tuition?
*
Yes
No
A portion
Applicant Acknowledgment of Commitments
The dates of the local overnight retreat are Friday, September 29, 2023 - Saturday, September 30, 2023. Full participation at the retreat is mandatory, no exceptions.
*
I agree to participate in the overnight retreat
I do not agree to participating in the overnight retreat
Tuition must be paid by Friday, August 4, 2023 and all parties previously listed in this application are responsible for payment to Leadership Broward Foundation, Inc.
*
I agree.
Class members must participate in one full-day session per month from October 2023 to May 2024. Class members must also participate in a group community project. No class member may miss more than two program days and graduate. No exceptions.
*
I understand and agree to fulfill the requirements listed above in order to graduate from the Leadership Broward Program.
LB will provide transportation during each program day. Class members are REQUIRED to utilize provided transportation during all program events. Personal vehicles or other forms of transport cannot be used during the program day. Class members are responsible for transportation to and from the pick up/drop off location.
*
I understand and agree to the transportation terms listed above.
Photographs are taken throughout the program year. Participants must consent to the use of these photographs in any literature or videos related to Leadership Broward Foundation, Inc. for marketing and/or informational purposes.
*
I agree.
Participants will be bound to the Leadership Broward Foundation Code of Conduct policy, as amended from time to time. Failure to adhere to this Code of Conduct may result in your removal from the Leadership Broward Program.
*
I agree.
I understand the goals and commitment of the Leadership Broward program and the attendance requirements. If selected, I will fulfill all obligations outlined in this application and will see to payment of my tuition upon acceptance. I acknowledge that I have completed the application and that all information contained herein is true and correct. I hereby give Leadership Broward Foundation, Inc. the right to make inquiries regarding the information provided on this application form. Please write your full name below, this serves as an electronic signature.
*
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