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Leadership Kitsap Program Application

2009-2010 CURRICULUM YEAR
Leadership Kitsap a non-profit organization, was founded in 1993 by community leaders, the Kitsap County Chambers of Commerce and the United Way of Kitsap County. The mission of Leadership Kitsap is to promote informed and committed civic volunteerism. The year-long curriculum is designed to help participants acquire both a fuller sense of the critical issues affecting Kitsap County and also the leadership skills necessary to motivate and engage others in collaborative efforts to resolve them.

SELECTION CRITERIA
Leadership Kitsap class participants are selected through a competitive screening/interview process conducted by the Board of Directors. A maximum of thirtytwo individuals will be chosen based on criteria including the following: commitment to civic involvement in Kitsap County, potential for community leadership, and professional as well as personal achievement.

SELECTION PROCESS
Application is a two-part process: (1) a written application submitted to the Leadership Kitsap office by August 20, 2009 and (2) a personal interview. All members of the Class of 2010 will be invited to attend the Leadership Kitsap Graduation Celebration held in June of 2009.

TUITION
Tuition for the curriculum year is $1950. At least $250 should be paid by the participant. The balance is usually paid by the participant’s employer or sponsoring organization. Partial scholarships are available however must be requested via separate application. Please contact the Executive Director (360) 782-1058 or email exdir@leadershipkitsap.org for more information.

NON-DISCRIMINATION
Leadership Kitsap does not discriminate against applicants or participants on the basis of race, religion, sex, national origin, sexual orientation, age, or physical ability.

CONFIDENTIALITY
All applications are handled respectfully and with appropriate confidentiality.

APPLICATION DEADLINE
All applications must be received no later than August 20, 2009.

INSTRUCTIONS FOR COMPLETION:
This application will take 45 minutes to an hour to complete. You cannot save your work, so you should have all material available before beginning. You may want to download a copy from the Leadershp Kitsap website and make notes prior to beginning (www.leadershipkitsap.org). Important Note: All candidates must complete an online application even if a hard copy has been submitted to the foundation office. During the first week of April, you will be contacted for a face-to-face interview.

Personal Information (Must complete entire application at once. Cannot save online)

Please answer all questions completely. Limit answers to space provided.
Name * First Last
Preferred Nickname
Home Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Home Phone * ### - ### - ####
Cell Phone ### - ### - ####
Home Email *
Emergency Contact
Emergency Contact Phone Number ### - ### - ####
Please select one
Years of Residence in Kitsap/Mason County
Ethnic Identity (Optional)
Employment Information
Current Employer
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Position Title
Responsibilities
Previous Employer 1
Employer Name
Position Title
Responsibilities
Employed from: MM / DD / YYYY
Employed to: MM / DD / YYYY
Previous Employer 2
Employer Name
Position Title
Responsibilities
Employed from: MM / DD / YYYY
Employed to: MM / DD / YYYY
Education 1

High School Attended
Name of School
City
State
Date attended (from): MM / DD / YYYY
Date attended (to): MM / DD / YYYY
Degree awarded
Education 2

Secondary education 1
Name of School
City
State
Date attended (from): MM / DD / YYYY
Date attended (to): MM / DD / YYYY
Degree/certificate awarded
Education 3

Secondary education 2
Name of School
City
State
Date attended (from): MM / DD / YYYY
Date attended (to): MM / DD / YYYY
Degree/certificate awarded
Academic and/or Professional Accomplishments

Include offices held, accomplishments, special awards, and honors.
List accomplishments here
What do you consider your greatest career accomplishment?
Community Leadership

Please describe present or past volunteer community involvement, including civic, political, government, social, athletic, or other community service (do not include business, professional, or academic leadership)
How many hours per month do you commit to volunteer work?
Organization 1
Name
From: MM / DD / YYYY
To: MM / DD / YYYY
Offices held (include committee chairs):
Your responsibilities:
Organization 2
Name
From: MM / DD / YYYY
To: MM / DD / YYYY
Offices held (include committee chairs):
Your responsibilities:
Organization 3
Name
From: MM / DD / YYYY
To: MM / DD / YYYY
Offices held (include committee chairs):
Your responsibilities:
Community Leadership Questions
What do you consider your most important accomplishment in one of the above organizations? Why?
What kinds of volunteer activites would you like to become active with in the future?
Application Essays

Please limit your answers to the spaces provided below.
What leadership qualities will you bring to the Leadership Kitsap class? What do you hope to gain from your participation in the program and how will you put it to use?
Briefly describe three pressing problems facing Kitsap/Mason counties. Giving a recommendation for solving each.
Describe three notable opportunities facing Kitsap/Mason counties. Give a recommendation for approaching (leveraging) one of them.
Time Committment

Leadership Kitsap, a personal and intensive training program, requires a one-year time commitment. The program works best for people who see themselves acting in leadership roles in their place of employment and in their community.

Full participation by each class member is expected. This includes attendance at:
- Orientation - One evening in Mid-August
- Opening Retreat - 2-day retreat in early September (Overnight)
- Monthly Challenge Days - October through June
- Leadership Development Day – 2nd Saturday in February
- Community Action Projects - to be scheduled by the class members in each group
- Graduation Celebration - late June
- Schedule subject to change

NOTE: To ensure that you can be an active participant during the coming year, please review these commitments to be confident that you, your family, and your employer understand these demands on your time, energy, and money. If you are unable to commit to this schedule, please do not apply at this time.
Financial Committment

Tuition for the Leadership Kitsap program is $1950. $250 of the tuition will be paid by the student with the remainder to be paid by the employer or sponsoring organization. Tuition is due by September 1, 2009. There are no refunds. For information on tuition assistance or individual payment arrangements, please call Gregory Hunt at 360-782-1058 or email exdir@leadershipkitsap.org.

Employer/Sponsor Tuition Contribution: $1700.00
Applicant Tuition Contribution: $250.00
TOTAL TUITION: $1950.00
Applicant's Signature*
Employer's Signature**
* Electronic signature only needed at this time (type in name). Once accepted into program, an original signed copy will be needed.
** Not applicable to partnerships, self-employed, unemployed or self-sponsored.
Sponsor Information (if applicable)
Name of Organization
Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Business Phone ### - ### - ####
Phone Fax ### - ### - ####
Contact Person
Contact Person Title
Contact Email Address
Business Web Site
Application Deadline

The deadline for submission of applications is March 31, 2009. All applications must be submitted online, however additional hard copies may be submitted to Gregory Hunt, Executive Director, Leadership Kitsap, 647 4th Street, Bremerton, WA 98337. Questions may be directed to: info@leadershipkitsap.org or by contacting (360) 782-1058. Limited partial scholarships available. Must mail a separate 100 word essay indicating reason for request.
Do Not Fill This Out

Wufoo

Leadership Kitsap Program Application

Personal Information (Must complete entire application at once. Cannot save online)

Employment Information

Previous Employer 1

Previous Employer 2

Education 1

Education 2

Education 3

Academic and/or Professional Accomplishments

Community Leadership

Organization 1

Organization 2

Organization 3

Community Leadership Questions

Application Essays

Time Committment

Financial Committment

Sponsor Information (if applicable)

Application Deadline