Annenberg Alchemy

CONNECT TO ALCHEMY

We are thrilled you are interested in applying for Leadership Seminar, Alchemy’s gateway program. Applications for the 2011 Leadership Seminar will be accepted starting May 1, 2010 and ending October 31, 2010. There are only 135 training slots, so please apply as soon as possible online. Eligibility and priority will be given to nonprofit organizations that meet our basic requirements. Alchemy includes an intensive two-day training session, followed by a half-day session, approximately 75-90 days later. They will be led by nationally respected facilitators and local practitioners.

Please note completion of the application form does not guarantee automatic enrollment into Alchemy. Participation in Alchemy will in no way inform or shape your ability to seek funding from the Annenberg Foundation. We will do our best to accommodate all qualified nonprofit leaders who are interested in participating in Alchemy.

The dates for the 2011 Leadership Seminar training are available as a downloadable PDF for your consideration prior to applying in June. There is no fee for admission, although full participation of the Executive Director and Board Chair is mandatory; therefore, it is important that you take the time to determine which dates will work best for both of you.”

We look forward to connecting with you in the coming weeks about joining Alchemy. If you have questions, please email us at info@annenbergalchemy.org or call us at (213) 403-3030.

I have read all the notes above and agree to the terms for application.

All * fields must be completed in order for your application to be accepted and processed by the Annenberg Foundation.

NONPROFIT ORGANIZATION

* EIN (Tax ID #) - [What is this?]	Example: 121234567 without dashes.
* Organization Legal Name:
* Fiscal Sponsor (if applicable):
* Year Incorporated:
* Organization Physical Address:
* City:
* State:
* Zip Code:
What is the general service area of your organization in Los Angeles County? (e.g. specific zip codes that your organization serves or targets, including zip codes of service sites, satellite offices, etc. Please separate each zip code with a comma.)
* Country:
Organization Mailing Address: (If different than Physical Address)
City:
State:
Zip Code:
Country:
* Phone Number:
* Fax Number:
* Website:
* Organization Annual Budget:

EXECUTIVE DIRECTOR
* Prefix (select one):
* First Name:
* Last Name:
* Preferred Name / Nickname:
* Job Title:
* Years of service as Executive Director * at this organization:
* Direct Work Number:
* Mobile Number:
* Email Address:

BOARD CHAIR
* Prefix (select one):
* First Name:
* Last Name:
* Preferred Name / Nickname:
* Years of Service as Board Chair:
* Company Affiliated With:
* Company Job Title:
* Direct Work Number:
* Mobile Number:
* Email Address:

BOARD CHAMPION – We highly recommend another board member attend, but not mandatory.
Prefix (select one):
First Name:
Last Name:
Preferred Name / Nickname:
Board Role:
Years of Service as Board Member at this organization:
Company Affiliated With:
Company Job Title:
Direct Work Number:
Mobile Number:
Email Address:

* How did you hear about Alchemy?

* If chosen to participate, please check all seminar dates below where all parties are able to attend together:

Session #	First Day		Second Day	Third Day
Session 10:	Saturday, January 8	and	Monday, January 10, 2011	Monday, April 11, 2011
Session 11:	Wednesday, January 12	and	Thursday, January 13, 2011	Monday, April 11, 2011
Session 12:	Friday, January 14	and	Saturday, January 15, 2011	Tuesday, April 12, 2011
Session 13:	Saturday, February 12	and	Monday, February 14, 2011	Monday, May 16, 2011
Session 14:	Wednesday, February 16	and	Thursday, February 17, 2011	Monday, May 16, 2011
Session 15:	Wednesday, March 9	and	Thursday, March 10, 2011	Monday, June 13, 2011
Session 16:	Saturday, March 12	and	Monday, March 14, 2011	Monday, June 13, 2011
Session 17:	Wednesday, March 16	and	Thursday, March 17, 2011	Tuesday, June 14, 2011
Session 18:	Saturday, March 19	and	Monday, March 21, 2011	Tuesday, June 14, 2011

Is there anything else you would like us to know?

Please note that is a three-day commitment for a minimum of two individuals from your organization. By pressing the submit button you are confirming your commitment.

Enter Security Code: