Be part of the BNLP Team! Now recruiting for BNLP Class of 2014!

City of Burbanks Connect with your Community Initiative, Leadership Burbank Alumni Association, and Burbank Unified School District invite you to be part of an amazing community-wide collaboration. Become a leader in your community Empower yourself Strengthen your leadership skills Make positive changes Improve the quality of life in your home, school, and community Pay it forward to your family, friends, and neighbors

The Burbank Neighborhood Leadership Program (BNLP) is a five-month program (January-May) for adults. This grassroots program gives you the tools to become leaders at home, work, school, and in the community. You learn the who, what, when, where, why, and how of leadership so YOU can be a leader! BNLP also connects you to Burbanks departments, nonprofits, and businesses. This is a volunteer program, and there is no fee to participate. All participants must be Burbank residents. Applications are due by 5 p.m. on Friday, October 25, 2013 Applications may be mailed or delivered to: Ovrom Community Center Attn: Paul Paolone 601 South San Fernando Blvd. Burbank, CA 91502 Finalists will be notified to attend a Meet and Greet with the BNLP Coordinating Committee on Saturday, November 9th at 9:00 a.m. If you have questions about this program, please contact Paul Paolone at (818) 238-5435 or via email at Paolone@burbankca.gov

Application for Class of 2014

Please answer all questions. INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED. If necessary, you may attach additional pages.

1. PERSONAL INFORMATION ____________________________________________________________________

NAME

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HOME ADDRESS

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EMAIL (required)

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CELL PHONE

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HOME PHONE MONTH AND DAY OF BIRTH, NO YEAR: ________________________________________________ CIRCLE YOUR AGE RANGE: CIRCLE T-SHIRT SIZE: S 18-28 M L 29-38 XL 39-48 XXL 49-58 59+

2. ABOUT YOU
A. Why are you interested in participating in the Burbank Neighborhood Leadership Program?

B. What do you hope to learn from this program?

C. What does leadership mean to you?

D. Describe a personal goal you have (personal, work-related, school-related etc) and what you are doing to achieve that goal:

E. Describe one of your proudest moments and why you felt so proud:

F. Tell us about something or someone that inspires you.

G. List workshops, classes, or seminars attended:

H. How did you hear about Burbank Neighborhood Leadership Program?

3. NEIGHBORHOOD & COMMUNITY YOUR VIEW

A. What do you consider the major issue(s) facing your neighborhood today?

B. If you could change something in the City of Burbank, what would that be? How would you change it?

C. Are you involved in your community (church, your neighborhood, school, PTA, etc)? What do you do there?

4. EMPLOYMENT
Are you currently employed? Where? __________________________________________________ Position ________________________________________________________________________

5. EDUCATION
What level of education did you complete? ___________________________________________ Are you currently enrolled as a student? Where? _______________________________________

6. COMMITMENT
Burbank Neighborhood Leadership Program consists of 10 classes held every other Saturday from 8:00 am3:00 pm over a five-month period (January-May). In addition, there is a Welcome Reception in December and Graduation in May. Additional out of class time is required to work on a Community Project. Each participant is expected to attend all 10 sessions, and actively participate in the Community Project to graduate from the program. The sessions are scheduled for, not including Community Project meetings: January 11 and 25, February 8 and 22, March 8 and 22, April 5 and 19, and May 3, 17 and Graduation on May 31st. In submitting this application and signing below, I understand and agree to the above terms and the time commitment required to complete this program. ________________________________ Signature ________________________________ Date