IMPACT Pasadena Application for 2027 Cohort - City of Pasadena

NOTE: Please be prepared to complete this application in its entirety upon starting as there is not an option to save and continue at a later time.

PERSONAL INFORMATION

First Name *

Last Name *

Cell Phone *

Personal Email *

Home Address

Address Line 1 *

Address Line 2

City *

Zip/Postal Code *

Birthday *

DEMOGRAPHICS

Gender *

Female Male

Ethnicity *

White Hispanic or Latino Black or African American Native American Asian/Pacific Islander Other

Number of years affiliated with Pasadena *

Do you currently reside in Pasadena? *

Yes No

EMPLOYMENT INFORMATION

Type of Business *

Present Employer *

Business Address

Address Line 1 *

Address Line 2

City *

Zip/Postal Code *

Title *

Responsibilities *

Date of Hire *

Work Phone *

Work Email *

PERSONAL & LEADERSHIP ASSESSMENT

1. How do you view yourself as a leader? *

2. What do you consider to be your three most important achievements? *

3. What do you aspire to achieve in life or in IMPACT Pasadena? *

4. If selected, you will be part of a cohort of leaders, how would you work to be an asset to IMPACT? *

5. What is your personal definition of leadership? *

5. How did you hear about IMPACT Pasadena? *

ADMINISTATIVE & FINANCIAL ASSESSMENT

Send Correspondence to: *

Home Address/Email Work Address/Email

RESUME & PROFESSIONAL BIOGRAPHY

Please upload a current resume if you have one and type a 150-word professional biography.

Resume

Professional Biography

Thank you for taking the time to complete this application, please see the information below. *

I agree

Please review the requirements to participate in the IMPACT Pasadena Leadership Program here. By checking this box, I verify that I have reviewed the IMPACT Pasadena Program Calendar and understand that if selected, there are certain attendance requirements that need to be fulfilled as a participant of IMPACT Pasadena. I agree to make my attendance a priority and understand the commitment required.

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