Apply Now Leadership St. Louis 2023-24 Application Two recommendations are also required. A link to the recommendation form will be emailed to you upon your application submission, or you can access the form here.Name* First Last Preferred Name Email* Title/Position* Employer/Organization* Preferred Mailing Address Home Work Home Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Work Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Preferred Phone NumberPhone Type Home Mobile Work Number of Years in the St. Louis region Are you a graduate of a FOCUS St. Louis program? Yes No If yes, which program(s)? Coro Fellowship in Public Affairs Emerging Leaders Experience St. Louis FOCUS Impact Fellows Women In Leadership Youth Leadership St. Louis Other DemographicsThe following questions help us to measure the diversity of our class and our outreach efforts.Date of Birth (in month/day/year format) MM slash DD slash YYYY AgeGender Female Male Non-Binary Prefer not to say Which categories describe you?Select all that apply. American Indian or Alaska Native Asian Black or African American Hispanic, Latino or Spanish origin Middle Eastern or North African Multi-Racial Native Hawaiian or Pacific Islander White/Caucasian Some other race, ethnicity or origin If other, please specify: Select county of residence.St. Louis City (MO)St. Louis County (MO)St. Charles (MO)Jefferson (MO)Lincoln (MO)Warren (MO)Franklin (MO)Madison (IL)St. Clair (IL)Monroe (IL)Calhoun (IL)Macoupin (IL)Jersey (IL)Bond (IL)Clinton (IL)OtherEmploymentIn which sector do you work? Business/Corporate Education Entrepreneur Government/Public Service Health Care Labor Legal Nonprofit Volunteer Describe your current major job responsibilities.Number of years with current employer.Please list your previous employment.I. Dates - To/From I. Title/Position I. Employer I. Major ResponsibilitiesII. Dates - To/From II. Title/Position II. Employer II. Major ResponsibilitiesIII. Dates - To/From III. Title/Position III. Employer III. Major ResponsibilitiesIn terms of your career, where do you hope to be in five years?EducationDegrees/CertificationsPersonal PerspectiveWhat specific skills, knowledge or experience would you bring to this class of Leadership St. Louis?What personal or professional outcomes are you hoping to achieve through participation?How would you use your Leadership St. Louis experience in your community and profession?Community/Civic InvolvementPlease list no more than 5 civic organizations that you are or have been a part of, including dates.What do you consider to be your highest level of responsibility or greatest achievement to date?Which of these do you consider to be your single greatest service to the community? Why?How did you hear about Leadership St. Louis? Subscribe Yes, I'd like to receive emails about upcoming FOCUS events, civic engagement opportunities and programs. Before hitting Submit, please review the following requirements and check that you agree to each of them.* My employer supports my participation in the 2023-24 LSL program and all program days. I am willing to make the monthly September to May commitment for the 2023-24 LSL program. I am aware that my absenteeism will result in my being dropped from the program. I understand that all program fees are non-refundable. “You basically form 60+ new friendships with a group of people who will always have your back. I have mentors and coaches who are willing to drop whatever is going on in their lives and give me time when I need it.” Johnny Wang Leadership St. Louis 2015-16
