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Leadership San Jose Application

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Personal Information

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Employment Information

Street, City, State, Zip


List any leadership programs you have participated in previously:

List the major civic, business, and professional activities in which you have participated during the past three years. Indicate the nature of your participation, including any offices you have held.

General Information

Describe what you hope to contribute to the LSJ Cohort and what you hope to gain from the experience.

Please identify and explain a particular issue, opportunity or challenge you feel is crucial to the future of San Jose.

List two (2) people (personal or professional) who have knowledge of your qualifications and can speak to your suitability for the LSJ Cohort Program.


  1. Name
  2. Email
  3. Phone Number
  4. Title
  5. Relationship


  1. Name
  2. Email
  3. Phone Number
  4. Title
  5. Relationship

The tuition for Leadership San Jose Cohort Program is $3,200, or $3,000 for non-profits. Each participant, as an indication of personal commitment, is expected to personally contribute $100 to the program tuition. Other sources, such as an employer or sponsoring organization, may be utilized to provide the balance. Limited scholarships are available for nonprofit applicants, reach out to Janikke Klem for more information

Do you understand the statement about tuition

Important Dates
Application Deadline: August 2, 2024 The cohort meets on Thursdays unless noted. Class Schedule: Sept 13, 2024 - 9:00-2:30 (Friday), Oct 17, 2024 - 9:00-2:30 + early happy hour 3:00-5:00, Nov 21, 2024 - 9:00-2:30, Dec 12, 2024 - 9:00-3:30 + LSJ Holiday Party 4:00-6:30, Jan 16, 2025 - 9:00-2:30, Feb 20, 2025 - 9:00-2:30, Mar 20, 2025 - 9:00-2:30, April 17, 2025 - 9:00-2:30, May 15, 2025 - 9:00-2:30 + Alumni Event 5:30-7:30, June 5, 2025 - 9:00-3:00 Final Program day + Graduation celebration

Do you acknowledge the above dates?

Refund Policy Withdrawal from the program following confirmation of participation will result in forfeiture of tuition unless an alternate participant is confirmed prior to the first session. Attendance Policy The opening retreat for Leadership San Jose will take place on September 13, 2024. The retreat will take place at a local venue to be announced prior to the retreat.
Employer / Sponsor Commitment
Employer/Sponsor Commitment Leadership San Jose Cohort nominees must have the support and commitment of their sponsoring business or organization. The signature of the head of the sponsoring organization or the nominee's immediate manager is necessary as an indication of that support.

I agree to get a physical signature from my manager or sponsor prior to the date on which the application closes.

Name, Organization, Title, Email, Phone

Declaration Upon Completion of Application
In submitting this application, I hereby declare that: I have read the above statements and agree to the refund and attendance policies. Except for circumstances beyond my control, I will complete the program in its entirety.

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