Presidents Round Table

LAKIN INSTITUTE FOR MENTORED LEADERSHIP Application

Name: Position Title: College/District: Address: City: State: Zip Code: Office Phone #: Cell Phone #: Email: Fax #: Immediate Supervisor: Title:

Please attach: (1) an organizational chart showing the applicant’s position within the institution’s structure; (2) a resume (maximum 5 pages); (3) two letters of recommendation (one must be from the immediate supervisor); (4) high resolution jpeg picture (head-shot) to be used in the Lakin Institute directory; (5) the college/district and Lakin Fellow Agreement Form, (6) the application fee of $100 Upon acceptance, the Lakin Institute registration fee is required.

Using the space provided, please complete the following questions:

1. Why are you interested in participating in the Lakin Institute at this time in your career, and what do you seek to gain?

2. What are your professional career goals within the next two years and the next five years?

3. What is your ultimate career goal, and do you aspire to become a CEO? If so, Why?

1 4. Describe your experiences as a leader.

5. Describe your experience in community colleges.

6. Describe your community involvement and advocacy work.

7. Would you wish to work with a mentor and in what general areas?

8. Do you, your supervisor, or your college president/chancellor have a senior level professional at your institution or in geographic proximity who could serve as a mentor? If yes, please provide the contact information of the recommended Mentor*.

Yes______No______

Recommended Mentor*

Name: ______Title: ______College: ______Address: ______City: ______State: ______Zip Code: ______Telephone: ______Email: ______

*Note: Mentors must be members of the Presidents’ Round Table of African-American Community College CEOs. The Lakin Institute Committee will make all final mentor-mentee assignments.

Signature: ______Date: ______2 I have attached the following application materials: (1) an organization chart, (2) a current resume, (3) two letters of recommendation, (4) a high resolution jpeg picture, (5) the Lakin Mentor Leadership Application, and (6) the College/District and Lakin Fellow agreement form.

Send completed application and required attachments to: Dr. Kirk A. Nooks President Metropolitan Community College- Longview 500 SW Longview Road Lee’s Summit, MO 64081

Email: [email protected]