Application LJH 2017-18

Leadership Jackson Hole Application

                                                               Due:  August 28, 2017

 

 Application for Leadership Jackson Hole is open to people living or working in Teton County, Wyoming. Class members will be selected by the steering committee based on the applicant’s merits as presented in the application and supporting documents. The committee seeks representation from a cross-section of the county with diversity and balance in areas such as occupation, organizational affiliations, and individual attributes. The committee looks for:

  • Commitment and motivation for community service in Teton County.
  • Ability to make the time commitment.
  • Individuals who will add to the program and community leadership through diversity of perspective.
  • Position in employment and/or volunteer organizations resulting in potential to influence.

Nominees must have the full support of their sponsoring organization or employer. Individuals may nominate themselves, but must provide evidence that the employer will allow time for participation. Letters of recommendation from community members should accompany the application.

Attendance at all sessions is expected and is mandatory for the first session. Participants absent from more than one session will not graduate.  Application is due August 28, 2017. Notification will be made by September 4, 2017.

Please type or print:

  1. Personal Data

 

Name: _________________________________________________________________________________

Mailing Address: _________________________________________________________________________

City, State, Zip: ________________________________________ Home phone: ______________________

Home fax: ____________________________________________  Home email: ______________________

Name of Employer: _______________________________________________________________________

Business Address: ________________________________________________________________________

City, State, Zip: ________________________________________ Business Phone: ___________________

Business Fax: __________________________________________ Business email: ___________________

Occupation or job title: ___________________________________________________________________

Male or Female: __________________________________            Years in Teton County: _________________

What special accommodations do you require? ________________________________________________

 

  1. Leadership Information

 

  1. Employment: (please list your jobs for the last 5 years):

 

Employer                                                           Job Title                                                     Dates of Employment

       _______________________________________________________________________________________

 

     ________________________________________________________________________________________

 

        ________________________________________________________________________________________

       

        Briefly describe the major duties/responsibilities of your current job: ________________________________________

 

        ________________________________________________________________________________________

       

        ________________________________________________________________________________________

 

  1. Community Activities/Organizations:   List your involvement in community activities, organizations, volunteer work, business and professional groups in the last 5 years.

 

                     Organization                                                    Position                                       Accomplishment

_______________________________________________________________________________________________

 

_______________________________________________________________________________________________

 

_______________________________________________________________________________________________

 

_______________________________________________________________________________________________

 

 

  1. Education:   List your formal and informal education experiences beginning with most recent.

                  School/Organization Name                           Course/Degree Completed                                     Dates

_______________________________________________________________________________________________

 

_______________________________________________________________________________________________

 

_______________________________________________________________________________________________

 

_______________________________________________________________________________________________

 

  1. Interest:   Why do you want to be selected for Leadership Jackson Hole?  _______________________________________________________________________________

      _______________________________________________________________________________

_______________________________________________________________________________

 

      What specific skills/knowledge do you hope to gain from the LJH program?         _______________________________________________________________________________

      _______________________________________________________________________________

      _______________________________________________________________________________

 

      How do you plan to use what you learn? ______________________________________________

      _______________________________________________________________________________

      _______________________________________________________________________________

      _______________________________________________________________________________

    

What contribution can you make to the LJH program?  _____________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

 

What do you believe are the two most important opportunities or problems facing Jackson Hole?

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

 

III. Commitment

  1. Employer: This candidate has my full support to participate in Leadership Jackson Hole.  I

      am aware of the time commitment involved in his/her effective participation, and I agree to

      support him/her in work release time.

 

Name (printed) __________________________________________________________________

Title__________________________________________________________________________________

Business or organization _________________________________________________________________

Employer’s Signature________________________________________    Date _____________________

These are the dates for the 2017-18 Institute.  Please clear these dates with your employer and sign that you are able to attend.

 

September 20             Introduction to Leadership and Team Building

October 18                 Generational Differences & Communication                                                      

November 15             Organizational Culture & Ethics

December 13              Improving Speaking & Listening Skills &Social Action Process          

January 17                 Local & State Economy & Government Functionality

February 26-28         Class trip to Wyoming Legislature in Cheyenne                          

March 21                   Conflict Resolution & Negotiation

April 18                      Energy and Environment                                       

May 16                       Social Responsibility & Graduation

 

  1. Applicant:  I understand the goals and commitments of Leadership Jackson Hole.  If selected,

I will devote the required time and I have reserved these dates. I agree to arrive on time and commit to stay through the entire day’s sessions. I also understand that each month there are additional Community Based Experiences, which will need to be added to the schedule.

Applicant’s signature__________________________________________            Date_____________________

Tuition is $300, due August 28 and is non-refundable to individuals selected for participation.  Leadership Jackson Hole reserves the right to cancel or modify the course.

 

Return to:

Leadership Jackson Hole

Teton County Extension Service

P.O. Box 1708

Jackson, Wyoming 83001

If you are enrolled in the University of Wyoming:  Leadership Jackson Hole can be taken for University of Wyoming Credit.   The course syllabus is available in the Extension Office

FCSC 4985/5985 – Seminar: Development in Community Leadership  – 3 credits hours