Leadership Columbus | Signature Program Application

Salutation:*

Mr.
Mrs.
Ms.
PhD.
EdD.

Name*

First Last

Employer:*

Title*

Organization Type*

Medium to Large Business (>100 employees)
Small Business (<100 employees)
Government/Public Sector
Social Services/Nonprofit

Industry Type*

Briefly describe your current responsibilities at work:*

Personal Email Address:*

Work Email Address:*

Personal/Cell Phone:*

Work Phone:*

Home Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Work Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Where do you prefer to receive your email communications?*

Personal
Work

Where do you prefer to receive your mail?*

Home
Work

Are you a previous Signature Program applicant*

Yes
No

How many years have you lived in the Columbus region?*

Do you anticipate relocating within the next three years?*

Yes
No

Leadership Columbus encourages individuals who have a passion for community trusteeship to apply to the program. What is your primary volunteer role at this time?*

Organization Position Your Responsibilities

Please list up to three other civic, professional, community or social organizations in which you have participated (past or current).*

Organization	Responsibility	Dates of Service (From/To)

How many hours per month do you currently commit to volunteer activities?*

(on average)

Please list special awards, accomplishments, honors, offices held, etc. during your academic and professional career.*

What specific evaluations/assessment testing have you previously taken? (e.g., 360 evaluation, Myers Briggs Personality Test, Riso-Hudson Enneagram Type Indicator (RHETI), etc.)*

Letter of Recommendation #1*

Your two letters of recommendation should be from individuals who are familiar with your leadership/volunteer interests and activities. If your organization is providing financial sponsorship, at least one letter should be from your supervisor or a senior manager in the organization and should address: • how the letter writer knows the applicant and the length of their acquaintance • an assessment of the applicant’s demonstrated leadership qualities • an assessment of the applicant’s commitment to becoming involved in the civic agenda • the employer’s commitment to support the applicant (time and financial obligation)

Name	Title	Employer	Email Address	Phone

PLEASE UPLOAD your first letter of recommendation.*

Max. file size: 512 MB.

Letter of Recommendation #2*

Your two letters of recommendation should be from individuals who are familiar with your leadership/volunteer interests and activities. If your organization is providing financial sponsorship, at least one letter should be from your supervisor or a senior manager in the organization and should address: • how the letter writer knows the applicant and the length of their acquaintance • an assessment of the applicant’s demonstrated leadership qualities • an assessment of the applicant’s commitment to becoming involved in the civic agenda • the employer’s commitment to support the applicant (time and financial obligation)

Name	Title	Employer	Email Address	Phone

PLEASE UPLOAD your second letter of recommendation.*

Max. file size: 512 MB.

PLEASE UPLOAD the signed Applicant/Supervisor Attendance Agreement and the Applicant/Sponsor Payment Agreement found in the application instructions on pages 6-8.*

Max. file size: 512 MB.

All applicant agreement signatures must be included on these pages.

PLEASE UPLOAD a copy of your resume.*

Max. file size: 512 MB.

1. Leadership Columbus will help you focus, connect and grow. For us to better meet your objectives in these areas, please thoughtfully respond the following three-part question: a. Explain how you would like to grow professionally and personally and apply your newfound knowledge. b. How will your personal background/experience/upbringing contribute to the overall learning experience of the class? c. Explain how you would like to connect and be involved in the community five years from now.*

2. What is ‘leadership’ to you and how have you demonstrated this in your own life? Include ways you may not have lived up to your own definition and what you have learned from those experiences.*

3. What are two significant challenges/problems facing the Columbus region that you would like to address? Then, please choose one, explain why it is so significant and provide your recommendations for resolving this challenge/problem and being part of the solution.*

4. (Optional) Is there anything else you would like the Selection Committee to know about you that you believe would assist in the selection process?

If accepted, do you plan to register for the optional Nonprofit Board Governance Training on June 22, 2023 for an additional $500?*

How did you learn about the Leadership Columbus Signature Program?*

(check all that apply)

Recruitment Session
Work
Social Media
Self-Inquiry
Word of Mouth
Alumnus
Other

If you chose "Other", please let us know how you learned about the Signature Program.

Signature Program Application

Application for the Signature Program Class of 2023