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:
- 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? ________________________________________________
- Leadership Information
- 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: ________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
- Community Activities/Organizations: List your involvement in community activities, organizations, volunteer work, business and professional groups in the last 5 years.
Organization Position Accomplishment
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
- Education: List your formal and informal education experiences beginning with most recent.
School/Organization Name Course/Degree Completed Dates
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
- 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
- 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
- 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