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2008 Leadership Portland Application for Appointment

Please read the application instructions before submitting application.

Please complete each section completely. Essay answers should be 150 words or less.
If you have questions, please contact the Program Coordinator at 503.552.6775.

Personal Information

First and Last Name:
Preferred Name:
Home Address:
Home Phone:
Length of residence in the Portland region:
Place of residence prior to living in the Portland region:
Hobbies:

Employer Information

Company/Organization Name:
Business Address:
Applicant's Position Title:
Hire Date:
Business Phone:
Business Fax:
Business Email:
Financial Sponsor:
Billing Address:

Education

Highest level of education:	High School Some College Undergraduate Post-Graduate
School Name/Degree:
Academic Achievement, Community or Professional awards:

1. Community Involvement/History

Describe your involvement in current or past civic activities and what motivated you to become involved. How much time do you currently devote to volunteer work?

2. Leadership Potential

Give one example of your greatest personal or professional achievement. Please describe the achievement, your role in the effort, leadership qualities you demonstrated, how the effort affected the community and any personal reflections you would like to share.

3. Commitment to the Community

What skills do you hope to develop further through participation in Leadership Portland, and in what ways do you see yourself contributing to your community in the future?

4. Innovation

Please provide us with an example of a situation where you demonstrated creativity, innovation or unique-problem solving skills to design or improve a system, product or service.

5. Other

You've had an opportunity to answer a number of specific questions about yourself. Given that the mission of Leadership Portland is to develop community leaders, what else do you believe we should know about you as a candidate for this program? You may either add to something you have already said, or provide additional information you believe to be relevant to your candidacy.

6. Diversity
OPTIONAL: In order to select a class that is representative of the diversity of our community, we would like to encourage you the complete the following information:

Size of Business:	0-5 6-50 51-500 Over 500
Type of Business:	For profit Non-profit
Gender:	Male Female
Age:	20-29 30-39 40-49 50-59 Over 60
Ethnic/Cultural Indentification:	Caucasian African American Hispanic Asian Native American Eskimo/Pacific Islander Other:
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