I. APPLICANT DATA:

Full Name: / Prefer to be called:
Company or Firm Name:
Title:
Business Address: / City, State, ZIP:
Business Phone: / Business Fax:
Supervisor Name/Title: / CEO:
Home Address: / City, State, ZIP:
Home Phone: / Preferred Email:
Preferred mailing address:
Home Business
How did you hear about this program?

II. PREVIOUS EMPLOYMENT (List in reverse chronological order):

Employer / Occupation/Title / From/To
1.
2.
3.

III. EDUCATION:

College/University / Location / From/To / Degree
1.
2.
3.

IV. COMMUNITY INVOLVEMENT

Do not include professional/business affiliations. Specify years of involvement.

Organization / Role/Position Held / From/To
1.
2.
3.
4.
5.

Please explain what you consider to be your most important accomplishment in one of the above organizations. How did you exhibit a leadership role?

V. What are your expectations for this program?

Why are you interested in serving as a board member for an arts, science or history organization?

What would you like to learn? Why is this training right for you at this time?

VI. letter of recommendation

In addition to the required employer commitment form below, please submit a second letter of recommendation from a personal or professional reference who can speak to your community leadership, readiness for ASC’s CLT Program and your commitment to arts and culture.

VII. Applicant Skills Inventory

The CLT program will place accepted applicants as board or apprentice members on cultural boards upon successful completion of the program. To enable us to make the best possible match for you with an appropriate board, both as an observer and as a board member, please complete the following:

In what areas do you consider your skills and abilities to be strongest? (check all that apply)

Architecture/Space Planning / Organizational Management / Strategic Planning
Computer/ Technology / Public Relations/Advertising / Program Development
Financial Accounting/ Planning / Human Resource Management / Marketing and Market Research
Fundraising/Development / Graphic Design / Legal
Event Planning / Real Estate Management / Other:

VIII. Applicant Arts & Cultural Interests

One of the necessary criteria for good board members is an interest in the programs, activities and/or art forms produced or presented by the organization they serve. Therefore, knowing which types of cultural groups and organizational characteristics interest you will be important. Please complete the following:

I am interested in the following arts & cultural areas (check all that apply):

Dance / Literary Arts / Other:
Theatre / Media Arts
Vocal Music / History/Heritage
Instrumental Music / Science
Visual Arts / Arts Education

Ix. APPLICANT DEMOGRAPHICS

Gender:

Male / Female

Age range:

21-29 / 30-39
40-49 / 50+

Ethnicity:

African American / Native American
Asian American / White/Caucasian
Hispanic/Latino / Other:

X. TIME COMMITMENT & ATTENDANCE POLICY

The nine-month program includes: an extended orientation session in September and eight (8) program sessions (approximately 3.5 hours each) between October and May; board observations; social gatherings; and a culminating graduation event. These activities will be augmented by facilitated placement as an apprentice board member, committee member or full term member of a cultural board.

2017 – 2018 Program Dates:

Session One/Orientation – Thursday, Sept. 21st (3-7pm)
Session Two – Thursday, Oct. 19 (3:00-6:30pm) / Session Six – Thursday, Feb. 8 (3:00-5:30pm)
Session Three – Thursday, Nov. 16 (3:00-6:30pm) / Session Seven – Thursday, March 15 (3:00-6:30pm)
Session Four – Thursday, Dec. 14 (3:00-6:30pm) / Session Eight – Thursday, April 19 (3:00-6:30pm)
Session Five – Thursday, Jan. 18 (3:00-6:30pm) / Session Nine – Thursday, May 17 (3:00-6:30pm)

*Dates/times may change slightly in some cases.

Additional Events (dates TBD):

CLT Graduation – June 2018 – TBD

The success of the CLT program depends on the full commitment of each participant to attend all program sessions, arrive on time and participate fully. While we recognize that emergencies do arise, more than two unexcused absences will result in dismissal from the program and forfeiture of tuition.

XI. Program FeeS

Please note that the CLT program fees are as follows:

Corporate Professional Rate: $900/person

Nonprofit Professional or Full-Time Volunteer Rate: $650/person

Fees may be paid by the individual or sponsoring employer and will cover all program expenses. Do not include payment with this application; participants will be billed after the selection process has been completed, and payment is due before the first session. Payment may be made by check or credit card.

NOTE: Partial scholarships are available and will be awarded based on need. If you would like to be considered for a scholarship, please submit a letter expressing your interest in the program and explaining why it is important that you receive scholarship support in order to participate. It will also be helpful if you can let us know how much you are able to contribute, and our committee will make a decision. Please include this letter along with your application form. In the event a scholarship is not available, we are also willing to work out payment plans with participants on a case-by-case basis.

XII. PARTICIPANT COMMITMENT

I understand the purpose of CLT and if selected, I will devote the time and resources necessary to complete the program. Even though emergencies do arise, I understand that full participation is expected for all sessions, group activities and events.

Failure to comply with this policy may result in dismissal from the program and forfeiture of tuition. If you (and your employer, if applicable) are unable to make this commitment, it is not in your best interest to apply. Are you (and your employer) willing to make such a commitment?

Yes No

Applicant’s Signature: / Date:

XIII. EMPLOYER COMMITMENT & RECOMMENDATION NOTE: If you are a full-time volunteer or self-employed, please submit a second Letter of Recommendation (see VI) in lieu of Employer Commitment.

This application has the approval of this organization, and the applicant has our full support, which includes the time required to fully participate in the program.

Name: / Title:
Organization:
Signature: / Date:

In the space below, please describe briefly the contributions of skills and experiences you believe the applicant would make to the Charlotte-Mecklenburg cultural community:

APPLICATION DEADLINE

All applications should be submitted to ASC no later than 5PM on June 20, 2017.

Electronic submissions are preferred and can be emailed to .

NOTE: Email submissions will only be accepted if submitted as a PDF file with all required signatures.Make sure your submission includes all of the following!

Completed application form

Participant commitment

Employer commitment and recommendation

Second letter of recommendation

1