News & Press
| Leadership Excel |
07/07/09 |
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CONFIDENTIAL APPLICATION LEADERSHIP EXCEL PROGRAM 2009-10 PERSONAL INFORMATION Name_____________________________________________________________________________ Last First Middle Preferred Name_________________ Male Female Race_________ Birth Date________ Home Address_____________________________________________________________________ Number Street City State Zip Years in Region_________Business Phone_ _ Cell Phone_____ ____________ Spouse____________________________________________________________________________ Children Names & Ages_____________________________________________________________ __________________________________________________________________________________ EDUCATION Briefly summarize your educational background. List degrees/certificates received, field of study, vocational training programs, professional institutes, etc. __________________________________________________________________________________ __________________________________________________________________________________ EMPLOYMENT Present Employer ___________________________________ Date Hired_____________________ Mailing Address____________________________________________________________________ Business Phone_____________________________________ Fax____________________________ E-Mail Address____________________________________________________________________ Type of Business____________________________________________________________________ Present Title ____________________________________ Since (Date)________________________ Briefly describe your responsibilities in your employment:________________________________ __________________________________________________________________________________ __________________________________________________________________________________ Please list the business, professional or job-related organizations of which you have been a member and that have been significant importance to you. Organization From To Responsibility/Positions Held Please list the community, civic, political, athletic, religious, cultural, or other organizations of which you have been a member and that have been of significance to you. Organization From To Responsibility/Positions Held RECOMMENDATIONS Sponsoring Organization/Corporation This candidate has my full support to participate in EXCEL. I am aware of the time commitment involved for effective participation, as well as the financial obligation. ____________________________________________________________________________ Signature Corporation/Organization ____________________________________________________________________________ Title Date Personal Recommendation: Please list a person other than sponsor who is knowledgeable about your leadership performance and potential. You may submit ONE letter of recommendation. ____________________________________________________________________________ Name Phone ____________________________________________________________________________ Address City State Zip EXCEL INSTRUCTIONS FOR APPLICATION Please complete each section fully. Limit answers to spaces available. One letter of recommendation will be accepted. No other attachments will be considered. Application must be signed by both sponsor and candidate and returned to: EXCEL P.O. Box 2125 Crowley, LA 70527 APPLICATION MUST BE TURNED IN AUGUST 21, 2009. After August Deadline, $25 late fee will apply ALL APPLICATIONS MUST BE RECEIVED BY SEPTEMBER 11, 2009 Class will be chosen in September by Selection Committee. COMMITMENT To graduate from EXCEL, a participant is expected to attend all of the sessions. One full weekday per month. Prior notification of absence must be given. A maximum of 2 absences will be allowed. Excess of 2 absences forfeits graduation . Orientation Weekend: Friday, September 25, 2009 from 8:00 am to 4:00 pm Saturday, September 26, 2009 from 8:00 am to 1:00 pm ATTENDENCE IS MANDATORY!!! Will you be able to fulfill the commitment of participating in the session, which will be one full weekday per month? YES NO Do you have the support of your employer for the time involved? YES NO Tuition for each participant is $300. (Refundable if not selected) Will you/your employer be able to fulfill this financial commitment? YES NO I understand and acknowledge the purpose and commitment of the EXCEL Program; and if I participate, I will devote the required time. __________________________________________ _________________________ Signature Date |
