Moraine Valley Community College

Moraine Valley Community College

Dr. Vernon O. Crawley Leadership Academy

Leadership Assembly Application

2016

Please complete all sections of the application and type your responses directly into the application form.
Section I – General Information
Name
Position / Title
Department
Supervisor
Section II – Purpose & Experience

·  Please list some of your leadership endeavors while at Moraine Valley.

·  Please list some of your leadership endeavors outside of Moraine Valley.

·  Please list some of your strengths, skills and abilities.

Section III – Application Statement

In 300 words or less, please respond to the following statement:

Taking into consideration your leadership goals, why do you wish to participate in the Leadership Assembly? What do you hope to learn by attending the Leadership Assembly and how do you plan to use what you learn?

Section IV – Signatures

______

Applicant’s Signature Date

______

Supervisor’s Signature (Acknowledgement of Application) Date