Leadership Tuscarawas

2011-2012 Application Form

Early Bird Registration Discount ($150 off of tuition) for the first 10 applicants who submit their application and payment by May 1, 2011.

Instructions:

Please read carefully. Failure to follow instructions may prevent the application from being considered.

Complete each section in full. The recommendations form, sponsor tuition form and memorandum of understanding must mailed, faxed or delivered to Leadership Tuscarawas.
Include two completed recommendation forms (or letter of recommendation).
Sponsor Tuition Form must be signed by both the applicant and the applicant’s employer or supervisor, as well as the financial sponsor if someone other than the applicant will be paying the tuition.
Memorandum of Understanding must be signed.
Application deadline is May 31, 2011.

Note: All approved applicants will be notified by the end of June.

Selection Criteria:

Applicants must live or work in Tuscarawas County.
If employed, applicants must have the full support of their employer or supervising organization. Individuals not affiliated with a business or organization may also apply.
Leadership Tuscarawas participants for the upcoming class will be selected by a volunteer Selection Committee on their own merits, based upon the information on their application and recommendation form. The committee is committed to selecting individuals who demonstrate high standards of personal integrity, who show evidence of leadership potential and commitment to community service, and constructing a class that is representative of a cross section of the community, including business, labor, government, education, the arts, community-based organizations, human services, and ethnic and minority groups. Since the number of appointments is limited, applicants who are not selected are encouraged to reapply in subsequent years.

1. Personal Information

Full Name (Preferred First Name for Name Tag)

Employer	Position/Title

Business Address	City ZIPCode

Business Phone Business Fax	Business e-mail

Home Address	City ZIPCode

Home Phone Home Fax	Home e-mail

Emergency Contact Contact’s Daytime Phone Contact’s Evening Phone

Years Residing in County Years Employed in County	Date of Birth Male Female

Food Allergies/Restrictions

Preferred e-mail for communications from Leadership Tuscarawas (check one): Work Home Both N/A

2. Employment Information (if applicable)

Length of Time in Current Position Type of Organization

Briefly describe your work responsibilities:

Listing of positions held (including active military duty) in reverse chronological order:

Employer	Title/Responsibility	From	To

3. Educational Background

Starting with the most recent first, please list all schools attended and other specialized training:

School/Location	Dates (from – to)	Degree/Training/Diploma

4. Activity Data

Major volunteer leadership roles: Please list, in order of importance to you, up to four of your most recent volunteer leadership roles. Include name and location of organization, dates of service and your responsibilities.
Organization/Location	Dates (from – to)	Responsibilities
1.
2.
3.
4.

If none, what factors have changed that now enable you to seek involvement?

What attributes do you have that make you an effective community leader/trustee? Give specific examples of how you have demonstrated these attributes.

5. Community Analysis

One of the goals of Leadership Tuscarawas is to build a network of community leaders who can enhance their problem-solving and other leadership skills by sharing perspectives and working together.

What are the two most significant problems facing Tuscarawas County today?
1.

What needs to be done about one of these issues?

What specific skills/knowledge do you want to gain from your participation in Leadership Tuscarawas?

How will you use the skills/knowledge you expect to gain to better Tuscarawas County?

6. References

In addition to this application are two reference forms that must be completed by two individuals, other than immediate family, who are knowledgeable about your leadership performance and future potential. It is your responsibility to ensure the recommendations reach Leadership Tuscarawas by May 31, 2011. If you have been previously nominated for participation by someone other than an immediate family member, that nomination form will serve as one recommendation and only one additional form is required.

7. Tuition/Costs – Tuition Grant Policy

Leadership Tuscarawas is funded by tuition and contributions. Tuition is set at $1,500 for the ten-month program and includes all training, materials and meals. All tuition is non-refundable.

Payment of tuition in full is required prior to the Bus Tour on August 30, 2011.

Tuition grants up to $500 are available through grants awarded by Leadership Tuscarawas, unless the individual qualifies for tuition grants provided through specific restricted donations. Those requesting tuition grants must submit the request to Leadership Tuscarawas on the form available at www.leadershiptusc.org by the application deadline of May 1, 2011 and provide sufficient justification demonstrating financial need.

Appropriate consideration of financial need will be based on:

Participant’s individual ability to pay
Participant’s employment status
Financial resources of participant’s employer
Size of participant’s employer
Expected value of participant to the program

The Board of Trustees reserves the right to:

Approve or reject any tuition grant request
Limit the amount of monies available for tuition grants based on available financial resources
Revise the tuition grant guidelines at any time without notice

WHO WILL PAY YOUR TUITION? (Check one) Self Sponsoring Organization Other

If tuition is paid by someone other than the candidate, financial sponsor must complete the following (it is your responsibility to ensure the sponsor tuition form reaches Leadership Tuscarawas by May 31, 2011 ) :
Sponsor Tuition Form

8. Participation/Commitment

Leadership Tuscarawas requires a serious commitment of time and energy, and applicants must be able to fulfill the attendance requirements.
Full participation of each individual is necessary, and attendance at each session is expected. Because emergencies or business needs may arise, a participant may miss one class session, provided they complete a board-approved make-up assignment by the next class session. Participants who are absent from more than one (1) monthly session, or who do not complete the required make-up assignment for a missed session, may be asked to withdraw from the program with no refund of tuition.
Participation in the bus tour & retreat is mandatory.
Participation may require time commitments outside class sessions.
Graduation does not signify an end, but rather a beginning of a lifetime of opportunity in the Leadership Tuscarawas Alumni Network. It is expected that graduates will lend their time, talent, expertise and leadership to local committees, boards and organizations when needed and called upon.
Graduates also have a responsibility to ensure the perpetuation of leadership in the community, and therefore, it is expected that they will support the work of Leadership Tuscarawas.

Please schedule the following dates on your calendar:

Orientation:	Late afternoon, Tuesday, August 16, 2011
Bus Tour:	August, 30, 2011
Retreat:	September 20, 2011
Monthly Sessions:	Second Tuesday of each month, full day (except graduation, which is an early evening ceremony)

	October 11, 2011	February 14, 2012
	November 8, 2011	March 13, 2012
	December 13, 2011	April 10, 2012
	January 10, 2012	May 8, 2012

Graduation:	May 2012- TBA

WILL YOU BE ABLE AND WILLING TO FULFILL THIS COMMITMENT? (check one) Yes No

The Class Community Project may require additional voluntary time commitments outside of class time.
WILL YOU BE WILLING TO PARTICIPATE? (check one) Yes No

9. Memorandum of Understanding

It is your responsibility to ensure the memorandum of understanding reaches Leadership Tuscarawas by May 31, 2011 .