<p> LAKIN INSTITUTE FOR MENTORED LEADERSHIP Application</p><p>Name: Position Title: College/District: Address: City: State: Zip Code: Office Phone #: Cell Phone #: Email: Fax #: Immediate Supervisor: Title: </p><p>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.</p><p>Using the space provided, please complete the following questions:</p><p>1. Why are you interested in participating in the Lakin Institute at this time in your career, and what do you seek to gain?</p><p>2. What are your professional career goals within the next two years and the next five years?</p><p>3. What is your ultimate career goal, and do you aspire to become a CEO? If so, Why?</p><p>1 4. Describe your experiences as a leader.</p><p>5. Describe your experience in community colleges.</p><p>6. Describe your community involvement and advocacy work.</p><p>7. Would you wish to work with a mentor and in what general areas?</p><p>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*.</p><p>Yes______No______</p><p>Recommended Mentor*</p><p>Name: ______Title: ______College: ______Address: ______City: ______State: ______Zip Code: ______Telephone: ______Email: ______</p><p>*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.</p><p>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.</p><p>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</p><p>Email: [email protected]</p><p>3</p>