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Application -
Part I |
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Instructions
• Please complete each section in full.
• Please let Connie
Lauderdale know by October 15 of your intent to apply
for the program
• Application must be received no later than December 5,
2008. |
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Applicant |
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Name |
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School District Name |
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Home Address
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City |
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State |
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ZIP |
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Email |
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Home phone |
(including area
code) |
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Business phone |
(including area
code) |
Tuition
Tuition of $1,400.00 for the
2009 Leadership WSSDA program is due January 23, 2009.
Tuition is fifty percent (50%) refundable following the
first session and prior to the second session. After the
second session, no refunds will be made. The $1,400.00
tuition will be paid by (please check all that apply): |
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Myself: Amount:
$ |
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My District:
(Purchase Order number required)
Amount: $ |
Sponsorship:
(from a local business or civic organiztion i.e. Rotary,
Kiwanis, etc.)
Indicate the organization:
Amount: $ |
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Other source:
Amount: $ |
Scholarships:
Tuition assistance may become available through funding provided by
Foundation or other grants. |
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If funding becomes available, I hereby request a partial (up to
$700)
scholarship assistance based on special need as detailed below. |
| Amount requested:
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$ |
| Reason for request:
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Commitment
Statement
I have cleared my calendar to participate in the 2009 Leadership WSSDA
program. If selected, I commit to attending all sessions. I will also
devote the time and resources necessary to complete the Leadership WSSDA
project. If applicable, I have my employer's support as indicated below.
I
agree (represents your signature) Date:
We recommend that you contact
your employer concerning the commitment of time to the
Leadership WSSDA program. |
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Application -
Part II |
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Selection committee
and scholarship decisions will be based, in part, on the information
from Part II of the application. |
| WSSDA
Director Area |
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| Size of
District |
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| Length of
Board
service |
years |
| Have you participated in any of the following WSSDA
activities?
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Other life experience
and/or governance training.
Please specify: |
Occupation:
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General
Information |
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1. Why do you want to participate in Leadership WSSDA and what do you hope
to gain from the experience?
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2. What contribution do you feel you could make to the Leadership WSSDA
program?
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3. What one accomplishment best demonstrates your leadership potential?
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4. List the leadership experiences, positions and/or activities that
qualify you as a candidate for participation in Leadership WSSDA (You
may wish to include awards or citations, etc.).
This application must be received by
December 5, 2008.
For more information, please contact
Connie Lauderdale by
email or phone at 360/252-3009.
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