AUGLAIZE COUNTY
ADULT LEADERSHIP PROGRAM
Class of 2015-16 Application
Instructions:
¨ Please type or print legibly in black or blue ink.
¨ Applications must be signed by the candidate and by the candidate’s employer and/or financial sponsor
¨ Applications must be returned to the Auglaize VALU program no later than September 10, 2015. Classes begin September 17. Qualifying candidates will be notified no later than September 10.
¨ Tuition payment of $350 is non-refundable after September 11, 2015.
Selection:
All candidates will need to complete an application form.
The class is limited to no more than 12 individuals who:
¨ ARE SINCERE IN THEIR COMMITMENT AND INTEREST IN SERVING AUGLAIZE COUNTY
¨ LIVE OR WORK IN AUGLAIZE COUNTY’S COMMUNITIES AND INCLUDE A CROSS-SECTION OF BUSINESS, INDUSTRY, SERVICE, EDUCATION, GOVERNMENT AND COMMUNITY GROUPS
¨ MAKE A COMMITMENT TO ATTEND EACH OF THE 10 CLASSES AND HAVE THE SUPPORT OF THEIR EMPLOYER TO DO SO
¨ EXPRESS A TRUE INTEREST IN LEARNING MORE ABOUT AUGLAIZE COUNTY
Class Schedule:
September 17, 2015 Opening/Orientation
October 15, 2015 Local Government
November 19, 2015 Education
December 17, 2015 Communications
January 21, 2016 Health & Human Services
February, TBA Justice & Safety Forces
March 17, 2016 Industry & Economic Development
April 21, 2016 Local History & Tourism
May 19, 2016 Agriculture
June 16, 2016 Graduation
Class of 2015-16
Personal Data
Name:
Business/Organization:
Title/Office:
Business Address:
Business Phone:
Email:
Home Address:
Home Phone:
Email:
Cell Phone:
Why do you want to be a part of the Auglaize VALU Class?
What do you expect to gain from your participation in the Auglaize VALU Class?
Commitment:
The VALU Class is a commitment of one day a month, from September thru June. Sessions will begin Thursday, September 17, 2015 and continue on the third Thursday of each month from October through June 2016 with the exception of February’s class. Class sessions are generally from 8 am to 4:30 pm, but may be adjusted. Absences are discouraged and can result in being dropped from the course.
The tuition commitment is $350 and is non-refundable after September 11, 2015. Payment is accepted from individual participants or from the individual’s employer. An invoice will be sent on request. Tuition covers all meals, materials, supplies and most transportation for the VALU classes. Participants may be asked to provide some personal transportation as well.
I understand the goals and commitments of the Auglaize VALU Class.
I agree to attend all sessions and devote the time necessary to be a contributing member of the VALU Class. I understand if I fail to meet these obligations, I may be asked to withdraw from the class.
Candidate signature: ______
Employer, please complete this section:
q I agree to pay the $350 tuition required of the VALU Class for the above
candidate. I understand tuition is non-refundable after September 11, 2015.
q I agree to allow my employee the time necessary to be an active member of
the Auglaize County VALU Class.
Business Sponsor Name: ______
Signature: ______
Title/Organization: ______
Please return completed form and tuition payment to:
Auglaize County VALU Class
PO Box 208
Wapakoneta, OH 45895
The VALU Class is sponsored by the St. Marys Area, Wapakoneta Area and Southwestern Auglaize County Chambers of Commerce.