Activities and Leadership Form

Activities and Leadership form

Name ______

Please list any organizations you are an active member of including sports, clubs, choirs, bands, student council etc. If you have an elected or appointed leadership role (including manager or supervisor at a job), please note that as well. For any non-school activity, please give the name of an unrelated adult who can verify your participation and their phone number or email address.

Organization / Year(s) of participation / Leadership role
(if applicable) / Adult who can verify / Adult’s phone number
(if not a Chippewa teacher)
9 10 11 12
9 10 11 12
9 10 11 12
9 10 11 12
9 10 11 12
9 10 11 12
9 10 11 12
9 10 11 12
9 10 11 12
9 10 11 12
9 10 11 12
9 10 11 12
9 10 11 12
9 10 11 12
9 10 11 12
9 10 11 12
9 10 11 12
9 10 11 12
9 10 11 12
9 10 11 12
9 10 11 12
9 10 11 12
9 10 11 12
9 10 11 12
9 10 11 12

.

Please list other individual activities where you led or helped lead a group that did not fit in the chart on the front. Include an approximate number of hours preparing and leading the group as well as the date(s) of the activity and an unrelated adult who can verify your leadership. Do not include any project that you have already listed for service. Below include anything else you believe the Faculty Council should know about your leadership that does not fit into the categories given.

Description of leadership activity / Date (s) / Number of hours / Adult to verify / Adult’s phone number

Other information for the Faculty Council about leadership ______