LAKIN INSTITUTE FOR MENTORED LEADERSHIP

College/District and Lakin Fellow Agreement Form

This document contains the responsibilities of the Presidents’ RoundTable, the college and the Fellow in fulfilling the requirements of participation in the Lakin Institute for Mentored Leadership. Please review the form and have it signed by your college/district CEO and return it as indicated in the acceptance letter.

Presidents’ RoundTable Responsibilities:

  • Provide the curriculum, leadership, support and guidance throughout the program.
  • A five-night, six-day intensive leadership institute at a hotel site located in close proximity of the host community college/district. (covers tuition, books, case materials, and most meals).
  • Provide access to a network of experienced Mentors and Lakin Institute graduates.
  • Provide individual mentoring tailored to assist participants in professional development and in the pursuit of his/her professional goals.
  • A professional leadership profile of each participant.

College/District Responsibilities:

  • In support of the professional development of the Fellow, the college agrees to release the employee for the duration of the Institute and to provide funding to the extent possible.

Participant Responsibilities:

  • Complete the entire program. Fellows who do not attend all mandatory Institute workshops will not graduate from the Institute. They will be allowed to complete the program the following year.
  • Be responsible for their hotel lodging, transportation and additional meals not covered by the Institute.

REQUIRED SIGNATURES

Applicant:

______

Print nameSignature

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Applicant’s Supervisor:

______

Print nameSignature

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Applicant’s College President/Chancellor:

______

Print nameSignature

Please check appropriate response:

Applicant responsible for paymentCollege/District responsible for payment

College President/Chancellor: ______

Print nameSignature

College/District: ______Date:______

Address: ______

City/State/Zip: ______

Phone: ______FAX: ______E-mail: ______

If accepted in the Lakin Institute for Mentored Leadership, I agree to participate in all mandatory activities planned for the Institute.

Signature: ______Date: ______

I have attached the following application materials:
(1) an organization chart, (2) a current resume, (3) two letters of recommendation,
(4) a high resolution jpeg picture,(5) the Lakin Fellow Leadership Application,
and (6) the College/District and Lakin Fellowagreement form.

Send completed application and required attachments to:

Dr. Kirk A. Nooks

President

Metropolitan Community College- Longview

500 SW Longview Road

Lee’s Summit, MO 64081

Email:

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