Application Form

Complete the Application below and click the Submit button when finished. Upon acceptance to this program, the College of Continuing Education will send you a Registration Agreement which will need to be completed, signed and faxed to (916) 278-4865 in order for your application to be valid.

 

*Required Fields

 

Applicant
  Formal Name (this name will appear on formal documents, i.e., certificate)
First Name *   Last Name *
 
 
  Preferred Name * (for nametags and class rosters):
 
  Working Title *
 
 
Agency / Department / Organization *
  Division *
  Office/Unit
 
  Civil Service Classification * (if applicable)

 
  Mailing Address *
 
 
City *   State *   Zip *
   
 
  Telephone*
 
  Email *
 
  How did you hear about the Leadership for the Government Manager Program? *
 
     
Applicant Demographic Information
  Gender: *      
 

Sacramento State University Alum?: *   Yes    No

 
  Leadership for the Government Supervisor Alumni?: *  
  Highest Level of Education: *    
     
Position
 
 
  Description of current duties: *
 
  List of previous experience and dates: *
 
   
Applicant's Manager
 
First Name *   Last Name *
 
 
  Working Title *

 
 
Agency / Department / Organization *
  Division *
  Office/Unit
 
  Civil Service Classification * (if applicable)
 
  Mailing Address *
 
 
City *   State *   Zip *
   
 
  Telephone *
 
  Email *
 
     
Professional Reference 1
 
First Name *   Last Name *
 
 
  Relationship *
 
  Mailing Address *
 
 
City *   State *   Zip *
   
 
  Telephone *
 
  Email *
 
     
Professional Reference 2
 
First Name *   Last Name *
 
 
  Relationship *
 
  Mailing Address *
 
 
City *   State *   Zip *
   
 
  Telephone *
 
  Email *
 
     
Short Answer Questions  
  1. In 500 words or less, please answer the following question: How would you and your organization benefit by your participation in Leadership for the Government Manager? *
 
  2. Do you currently have a mentor? *
Yes
No
 
  3. If yes, in what ways has he or she been helpful to you?
 
  4. What additional skills do you want to further develop? *
 
     
Cohort Information
 

Please review the dates below and select the preferred cohort. *
If this nominee is selected, we will make every effort to put them in the cohort indicated below, however, we are not able to guarantee a place in any cohort. Cohorts are selected to reflect a balance in many areas including IT/Programming, gender, department, etc.

 

 
     
 
     
 
     
Course Information
Program Title Price
Leadership for the Government Manager $3,879
 
     
By submitting this application, I understand that I am committing the time and effort for all eight courses of the program.

I further understand that, upon acceptance, the application becomes valid when the Registration Agreement is received by the College of Continuing Education.

 

*

If you have questions, please contact:

 

Sidra Zumot, Program Analyst, 916-278-4551, zumots@csus.edu
Oksana Kolisa, Sr. Program Coordinator, 916-278-2981, kolisao@cce.csus.edu