Leadership Institute - Warren County Economic Development Corporation

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Warren County Economic Development Corporation

Leadership Institute
Application

In reviewing applications, the Identification Committee uses the following criteria:

Applications to Warren County Leadership is open to persons living or working in Warren County.
Class members are selected by WCLI Identification Committee on their own merits based upon the information provided in the application. The Committee selects a diverse group of men and women from a cross section of Warren County including business, labor, education, arts, religion, government, community-based organizations, and non-profits. The Committee encourages persons of ethnic and minority origin as well as those with disabilities to make application.

Attendance at each class session is essential to the success of the class. Participants must attend all class sessions. Prior permission must be obtained from the program chair for an excused absence for any session and may be granted only in cases of extreme personal emergency and unavoidable business conflicts. Failure to attend or obtain prior permission for all class sessions may result in a participant not graduating from the program and forfeiture of tuition payments. In addition to the regular class sessions, class members are expected to participate in a class project.

2008 Warren County Leadership Institute Schedule (subject to change)
Session 1	January 10, 2008
Session 2	January 24, 2008
Session 3	February 7, 2008
Session 4	February 21, 2008
Session 5	March 6, 2008
Session 6	March 20, 2008
Session 7	(Bus Tour) March 29, 2008
Session 8	April 3, 2008
Graduation	April 17, 2008

The WCLI Identification Committee goals are to identify and select participants who demonstrate the following criteria:
- Persons who possess a strong desire, motivation and a commitment to serve in a place of leadership within Warren County and or the State of Iowa.
- Persons that hold a responsible position of leadership in employment and/or volunteer organizations resulting in the potential to have influence on important issues facing our communities, Warren County, and the State of Iowa.
- Ability to make the time commitment required by the program.

Due to size restrictions of each year's class, it is possible qualified applicants will not be chosen for the 2008 class. Applicants are encouraged to reapply in subsequent years.

Please complete each section in full. Application deadline is October 26, 2007 - Priority will be given to early applications.

Personal Information

Preferred mailing address:
Home
Place of Business

full name

address - line 1

address - line 2

city
,

state

zip

e-mail address

home phone		other phone
fax		Cellular/Mobile

spouse's name

name(s) of child(ren)

Please complete the following statements:

To me, Leadership is

Education

Please list High School, College, University, Graduate, Business, Technical and Vocational Schools below:

name of school

city
,

state

degree

name of school

city
,

state

degree

advance degree(s)/special awards/honors

Have you participated in a community or other leadership program? If yes, please list the name, program, and dates.

Employment

present employer

business address

city
,

state

zip

e-mail address

business phone

fax

type of organization

start date

supervisor's name

position(s) and responsibilities held

Previous Employment

employer name	title/responsibility	from	to
employer name	title/responsibility	from	to
employer name	title/responsibility	from	to

General Information

One of the goals of the Warren County Leadership Institute is to build a network of community leaders who can enhance their problem solving and other leadership abilities through shared perspectives and working together. Please answer the following:

In what ways would you like to direct your new leadership skills?
Elective Office:
National State County City School
Non Profit
Community Development
Other

What would you like to gain from WCLI program?

What do you feel are the most significant problems facing your community, Warren County, or the State of Iowa today? In your opinion, what changes must be made to improve the economy and lifestyle of your community in future?

In the next five years, what do you anticipate your leadership involvement to be?

References

List three people you have worked with in a professional or community involvement capacity.

name	company	address	phone

name	company	address	phone

name	company	address	phone

Tuition

Tuition for the Institute is $300.00, non-refundable, payable prior to the opening session. Participants are encouraged to contribute a minimum of $50.00 from personal funds. Typically the employer or organization will contribute the remainder.

Do you need information about financial assistance or special arrangement for the payment of tuition?
Yes No

Partial scholarships are available on a limited basis. Do you wish to be considered for a scholarship?
Yes No

Financial Assistance

** Please only complete this section if financial assistance is desired.

Please indicated which individual yearly income bracket you fall under:
$0 - $20,000
$20,000 - $50,000
$50,000 - $100,000
$100,000+

Number in Household:

Does your employer offer tuition reimbursement?
Yes No

If so, how much funding will your employer provide?

In the box provided, please explain in 1 to 2 paragraphs your need for financial assistance.

Warren County Leadership Institute is a learning experience of which requires a commitment by the participants and their employers. As a participant, I will attend all sessions as well as participate in a class project in order to make the class a success. I understand that prior permission must be obtained from the program chair in order to have an excused absence from any session, and 2 excused absences may be granted only in the event of extreme personal emergency or unavoidable business conflicts. Failure to comply with attendance requirements may result in not graduating from the program and forfeiture of tuition payments. I understand the goals and commitments of the Warren Leadership program. If selected, I will devote the time and pay my tuition by the opening session.

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