Fresno Chamber San Joaquin Political Academy

Contact Information

List all schools attended: High School, College, Business/Trade and/or short courses:
• High unemployment • Water quality/storage • Air quality • Maintenance of roads within the city • Congestion on freeways • Public safety • Quality public education • Health care • Illegal immigration • Land use issues/development • Taxes • Business environment • Lack of ready-to-build industrial parks/buildings

References

List four references (two business and two personal) whom we may contact to assess your leadership potential.
I understand my commitment for participation in the San Joaquin Political Academy and give my permission for you to contact the references listed. I hereby certify that all statements made in this application are true and complete. I agree and understand that any misrepresentation or omission of material facts herein will cause disqualification of my application. I understand that selection of applicants is the sole responsibility of the Board of Directors of the San Joaquin Political Academy.
In consideration of permission granted me by the San Joaquin Political Academy Board of Directors, to participate in the Leadership Academy, I hereby release and discharge the San Joaquin Political Academy and its agents, employees, officers and Board from all claims, demands, actions, judgments and executions which the undersigned ever had, or now has, or may have, or which the undersigned's heirs, executors, administrators, or assigns may have, or claim to have, against the above-mentioned entity and persons, or their successors or assigns, for all personal injuries, known or unknown, and injuries to property, real or personal, caused by, or resulting from, my participation in the San Joaquin Political Academy. I, the undersigned, have read this release in its entirety and understand all its terms. I execute it voluntarily and with complete knowledge of its significance.
If selected as a participant in the Academy, I hereby authorize the Academy to:

I understand that participation in the Academy requires open discussions, presentations, debates, writings, and videotapes. While the Academy will not publish or distribute any of those materials (writings, videos) produced or discussed during class without my express permission, it cannot guarantee the confidentiality of what is said and presented in class. The Academy does not permit individual audio or videotaping of classes. Academy staff or Board will handle all videotaping as part of classroom activities. All videotapes are property of the Academy.

Signature is required.