Gaylord/Otsego County Chamber of Commerce

Leadership Otsego County

PROGRAM APPLICATION

2008 – 2009

______________________________________________________

Please type or print neatly in ink your responses to the questions below.  Return this application to the Gaylord/Otsego County Chamber of Commerce.  Application Deadline: June 2, 2008.

PART I.  PERSONAL INFORMATION

Name________________________________________________ Home Phone______________________

                Last                                        First                        MI

Home Address__________________________________________________________________________

                                Street                                                                      City                         State                       Zip

Employer ___________________________________ Position/Title _______________________________

Work Address __________________________________________________________________________

                                Street                                                                      City                         State                       Zip

Work Phone _____________________________ E-mail Address _________________________________

Preferred Mailing Address: Work ____ or Home ____ (check one)                Years lived in this area? ________

Registered Voter: Yes ____ No ____

Spouse’s Name ___________________________

PART II.  EDUCATION

Begin with your most recent coursework/training completed; include relevant studies beyond highest degree received.

                Institution & Location                                      Dates                                      Degree/Area of Study

PART III.  EMPLOYMENT

Begin with current or most recent position.

Job Title:  __________________________                Employer:  ______________________ Dates:  ____________

Immediate Supervisor:  _______________________________ Phone Number: ______________________

Description of Responsibilities: ____________________________________________________________

Job Title:  __________________________                Employer:  ______________________ Dates:  ____________

Immediate Supervisor:  _______________________________ Phone Number: ______________________

Description of Responsibilities: ____________________________________________________________

Job Title:  __________________________                Employer:  ______________________ Dates:  ____________

Immediate Supervisor:  _______________________________ Phone Number: ______________________

Description of Responsibilities: ____________________________________________________________

Job Title:  __________________________                Employer:  ______________________ Dates:  ____________

Immediate Supervisor:  _______________________________ Phone Number: ______________________

Description of Responsibilities: ____________________________________________________________

PART IV.  MEMBERSHIPS and ACTIVITIES

List current and/or past memberships in organizations (professional, civic, social, political, etc) and any offices held, as well as any elected or appointed positions in public office.  Begin with the most recent.

                Organization                                         Office Held                                        Dates of Involvement

PART V.  AWARDS/RECOGNITION/INTERESTS

List any honors, awards, fellowships or special recognition you have received (include description and dates).

What are your personal interests, hobbies and/or leisure activities?

PART VI.  BRIEF ESSAY RESPONSES

On a separate sheet, type or print neatly in ink your responses to the following questions.  Please limit your responses to no more than 200 words per question.

1)       What do you consider to be the most significant contribution you have made to volunteerism in your community?  What are your current and/or future interests in community service?

2)       What do you consider to be the most significant contribution you have made to your professional field, company or organization?  What are your professional goals?

3)       What do you feel are the most important characteristics/qualities of a good leader?  Why?

4)       Given your response to Question 3, what do you hope to gain from Leadership Otsego County?

5)       List three significant opportunities or challenges that you see facing Otsego County.

TUITION:

Tuition for Leadership Otsego County is $450 ($600 if employer/organization is not a member of the Gaylord/Otsego County Chamber of Commerce).  Financial assistance may be available; if you need assistance, contact Bob Kasprzak at the Gaylord/Otsego County Chamber of Commerce.  Tuition includes the cost of materials, breakfasts, lunches, snacks and other program costs.

Tuition will be paid:

______ By applicant

______ By applicant’s employer

______ By a sponsor; Name of Sponsor:  ____________________________________________

LEADERSHIP OTSEGO COUNTY REQUIREMENTS:

All Leadership Otsego County class members must:

1.       Live or work in Otsego County;

2.       Have an interest in seeking key volunteer, public office, board or commission roles;

3.       Possess high standards of personal integrity;

4.       Possess potential leadership ability and a personal commitment to solving community problems;

5.       Be willing and able to commit the time necessary to complete the program.  Mandatory time commitments include the orientation session scheduled for Friday, September 12, 2008 from Noon to 5:00 PM, the nine (9) all-day sessions (7:30 AM to 5:00 PM) scheduled for September 16, October 21, November 11, December 9, 2008 and January 20, February 17, March 17,

        April 21, and May 19, 2009.  A Graduation Banquet is scheduled for Tuesday evening, June 2, 2009.

6.       Arrive on time for each class session and be in attendance the full day;

7.       Use of cell phones and pagers will not be allowed during the program and will be restricted to scheduled breaks only;

8.       Participate in a community project to learn first-hand about community needs and issues.  These activities will require time in addition to that spent in class sessions;

9.       Meet with your mentor a minimum of once each month, outside of the class sessions.

The Leadership Otsego County Selection committee will choose a maximum of fifteen (15) students for the 2008-2009 class.  Participants will be chosen through a comparative assessment from all applications received.  The intent of this selection process is to create a group of the best quality candidates, which represent a cross section of interests within Otsego County.

PART VII.  COMMITMENT AGREEMENT

Attendance is critical to your success in Leadership Otsego County.  Your prompt and complete attendance at each monthly session is required.  Full participation in Leadership Otsego County may involve a time commitment beyond the daylong monthly sessions, for such activities such as book readings and a community project.  In addition, an important component of Leadership Otsego County is meeting with a mentor throughout the program.  The minimum expectation is that you will meet with your mentor at least once a month.

PARTICIPANT STATEMENT OF COMMITMENT:

If I am selected as a participant in Leadership Otsego County, I will devote the required time and energy to participate fully in the program.

________________________________________________  ______________________________

Signature of Applicant                                                                                Date

EMPLOYER STATEMENT OF SUPPORT:

I support this applicant to Leadership Otsego County, and agree to provide him/her with the necessary release time to fully participate in all activities.

________________________________________________ _______________________________

Signature of Employer                                                                                Title

REFERENCES:

Please list two references we may contact with regard to your application:

_________________________________________________  ____________________________

Name                                                      Daytime Phone                                Relationship to Applicant

_________________________________________________  ____________________________

Name                                                      Daytime Phone                                Relationship to Applicant

APPLICATION DEADLINE AND NOTIFICATION

Return your application to the Gaylord/Otsego County Chamber of Commerce, P.O. Box 513, 101 W. Main Street, Gaylord, MI 49735.  Applications must be received no later than 5:00 PM

on June 2, 2008 to be considered for the program, which begins in September, 2008.

Applicants will be notified of their selection status no later than August 1, 2008.  Tuition payment will be due in full prior to the first session.

Leadership Otsego County is sponsored by the Gaylord/Otsego County Chamber of Commerce.  For more information about the program, contact Bob Kasprzak at 989-732-6333 or bobk@gaylordchamber.com.