Pennsylvania Springboard Application

Which Springboard Training are you applying for? *

Southeast Pennsylvania, June 24th-25th
Southwest Pennsylvania , July 8th-9th

First Name *		Last Name *
Email *		Phone *
Street *		Street 2
City *		State *	Select One... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware D.C. Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Alberta British Columbia Manitoba Newfoundland New Brunswick Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory Other
		Zip *

Which training track do you want to participate in? *	Activists Organizers and Community Leaders Future Candidates
Are you interested in participating in the 9-month Political Leaders Fellowship? *	Definitely Interested Somewhat Interested Uncertain Probably Not Interested Definitely Not Interested
How did you hear about CPL? *
Personal Statement Questions In order to tailor the training to the experience and goals of our participants, we ask that you complete the following 3 questions so we may better understand your current involvement in political leadership, your future goals, and how you see the Pennsylvania Springboard Training supporting your development as a political leader.
What Leadership Positions have you held? What have been your accomplishments? *
What political leadership positions are you interested in pursuing? *
What do you see as your greatest skills in political organizing? Weaknesses you'd like to address? *
Please paste a current resume into the box - do not worry about formatting *
Demographic Information (Optional) The Center for Progressive Leadership is committed to diversity in our programs, including gender, ethnic, racial, economic, sexual orientation and education. We ask that you complete these optional questions so we can assess our progress in creating programs that match the full diversity of Pennsylvania's communities.
Gender	Male Female
Age
Ethnicity	African/African-American Asian/Pacific Islander/SE Asian/Indian Subcontinent Latino/Chicano Middle Eastern Native American Caucasian Other
Other Ethnicity
Income	Under $20K $20K - $40K $40K - $60K $60K - $80K Over $100K
Educational Experience	Some High School High School Grad Some College Associate Degree Bachelor Degree Some Grad School Masters Degree Some Post-Masters PhD/JD/MD
Non Profit/Community Organizing Experience	None 1-2 Years 3-4 Years 4+ Years
Political Campaign/Organizing Experience	None 1-2 Campaigns 3-4 Campaigns 4+ Campaigns
What else should we know about you?
Click submit to your application for the Springboard Training.