2017 Institute for Leaders Application

2017 Institute for Leaders Application Full name: ______Name (for nametags, etc): ______

Home address: ______Home city/zip: ______Zip:______Cell Phone: ______

Email address: ______

Employer: ______

Work address: ______

Work city/zip: ______Zip:______

Work phone: ______

Professional title: ______

How long have you been in your current position?: ______

Supervisor’s name: ______

Supervisor’s signature, signifying their approval of ______your participation in this class

Food allergies/dietary restrictions: ______

Organizations/Activities and Affiliations: Organization: Position held/Participation: Dates of Membership:

Education: 2017 Institute for Leaders Application College/University:

Degree:

Other education (training, etc):

Leadership Programs Completed: Program Name: Offered by: Dates Attended:

Brief Essay Questions: Please use an additional sheet of paper to answer the following questions. 1.) Why do you want to participate in the Institute for Leaders program? 2.) What do you hope to gain by participating in the Institute for Leaders? 3.) What is your vision for the Great Lakes Bay Region, and what is your role in achieving that region?

4.) What responsibility do individuals have to help solve community problems?

Commitment Statements The Great Lakes Bay Regional Alliance Institute for Leaders is an investment that will return benefits to the participants, their organizations and their communities. The Institute is designed to further the leadership skills of the individuals who have demonstrated an interest and ability in community activities. It is critical that participants commit to attending all seminars and events.  I understand that if selected for participation in the Institute for Leaders, I will be expected to attend at least seven of eight full-day scheduled seminars, and I am aware of the dates. I understand that any unexcused absences will be grounds for dismissal from the Institute.

 I have discussed this with my supervisor/employer and they understand that I am expected to attend all seminars outlined in the curriculum. If the Institute dates conflict with work schedules, my employer has agreed to accommodate me and let me use excused absences or vacation/personal time off. I understand that participation in all training is critical and that unexcused absences may be grounds for dismissal.

 Upon graduation form the Institute, I am willing and able to participate in collaborative efforts to help improve the Great Lakes Bay Region.

Name: ______

Please submit this completed application, along with answers to the brief essay questions to: 2017 Institute for Leaders Application Moira Branigan, Great Lakes Bay Regional Alliance, 117 S. Main Street, Ste 3., Freeland, MI 48623 or a PDF can be sent to: [email protected]