Contact Information

Contact Information

Community Outreach and Engagement Division

952-563-8733
Title

Bloomington Leadership Program Application

Sections

Submit this form to apply for the Bloomington Leadership Program or download a PDF application and return it to outreach@BloomingtonMN.gov:

Your submission will be delivered to the  City of Bloomington's Community Outreach and Engagement Division. 

Space is limited. A selection committee will review and select participants. Be sure to provide enough information for the selection committee to learn about you (for example, one paragraph).

The program is offered in English. If you’d like to request a language accommodation, please contact the Community Outreach and Engagement Division

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Questions
How did you learn about the Bloomington Leadership Program?
Select all that apply
Are you able to commit to attend 80% of the program meetings (no more than 2 absences)?
Demographic information (optional)

This section is voluntary. Any information you provide us is private data. The information is used to help our staff use the most respectful language when addressing you, and to monitor our success at attracting a diverse cohort of residents for the Bloomington Leadership Program. Having leaders who reflect the community we serve builds connections, enhances trust and expands perspectives, which ultimately results in better service to all residents.
Race/ethnicity
Preferred gender pronouns
Age
Signature

I understand that if selected for the Bloomington Leadership Program and alumni network, participation in the activity(ies) or program(s) is completely voluntary and that the activity(ies) or program(s) being offered is for the benefit of the participant(s). The City of Bloomington shall not be liable for any claims, injuries, or damages, of whatever nature, incurred by the participant(s) which are directly or indirectly attributable to the negligence, whether passive or active, of the City of Bloomington, their agents, or employees, arising out of, or in connection with the activity(ies) or programs. On behalf of the participant(s) and myself, I understand that I am waiving certain legal rights by agreeing to this Waiver and expressly agree to release and discharge the City of Bloomington, their agents, or employees, from any such claims, injuries, or damages. I also understand this waiver includes any injuries that may result from the condition of facility used in the activity or program.  

I understand that City staff may take video or photos of City sponsored activities. By signing this application, I waive any objection to the City sharing my name and/or my image in its promotional materials. If I wish to object the use of my image, then I will make my request known to the City of Bloomington in writing.

The data supplied on this form will be used to process your application for the Bloomington Leadership Program. Per Minnesota Statutes, some of the requested data may be private. It is available to you, as well as the City of Bloomington staff and volunteers who need this information to perform their duties. Private data is not available to the public. Data may be shared as required by law. You are not legally required to provide this data, but without it the City of Bloomington staff may not be able to select you to participate in the program, and/or you may not receive updated information. The data is needed to distinguish the application from others.

The City of Bloomington does not discriminate against or deny the benefits of its services, programs, or activities to a qualified person because of a disability. To make a request for a reasonable accommodation, ask for more information, or to file a complaint, contact the Community Outreach and Engagement Division, City of Bloomington, 1800 West Old Shakopee Road, Bloomington, MN 55431- 3027; 952-563-8733, MN Relay 711.