LOANEDEXECUTIVE2017-18APPLICATION
PRESENTED BY
WITH SUPPORT OF GULF POWER COMPANY
Full Name:
Nickname/PreferredName:
Employer:
Position/Title:
Business Address:
Phone (W): _Fax(W):
Phone (C):
E-mail (W):
Supervisor:
Brieflydescribe your currentworkresponsibilities:
_
Do you have priorLoanedExecutiveexperience (please circle)? Yes / No
Please describe any non-profit or volunteerexperience includingleadership positions held:
_
Whywould you liketobe apart of the LoanedExecutive Program?
What personal qualities will make you a successful Loaned Executive? _
_
______
What skills/knowledge do you hope to gain from your involvement in the Loaned Executive Program?
Whatquestions or concerns doyouhave aboutbeing aUnitedWayLoanedExecutive?
_
______
What areas of philanthropy interest you most (i.e. Children, Elderly, Developmentally Disabled, Homelessness, Health, Financial Stability, Education, Other)?
ShirtSize (please circle one):SMLXL2X3X
Attendance Requirements
For the Loaned Executive Program to be truly meaningful, Loaned Executives have a responsibility to participate fully. Attendance at scheduled functions, as well as interaction among fellow LEs is essential to the total learning experience. For this reason, Loaned Executives must agree to the following attendance policy:
Loaned Executives will be required to volunteerapproximately 10 hours a month from February-December during normal business hours (8am-5pm). Attendance is expected for the Community Investment Process (February-May), is required for the Loaned Executive Orientation(July 12, 8am-4pm), and isstrongly encouraged forthe Leadership Training sessions.
If you attend 4 or more monthly Leadership Training sessions, you will be recognized at the Appreciation Luncheon in January 2018. To ensure the quality of the program for all participants, excessive absences will result in a dismissal from the Loaned Executive Program.
Loaned Executive Program Agreement
I understand the purpose of the Loaned Executive Program. If selected, I will devote the time and resources necessary to successfully complete the requirements.
Signature Date
Supervisor/EmployerEndorsement
If the candidate on this application is selected to participate in United Way of Escambia County’s Loaned Executive Program, they will be required to volunteer approximately 10 hours a month from February-December during normal business hours (8am-5pm). This commitment includes monthly Leadership Training sessions (usually on the second Thursday of the month) July through December. To learn more about specific requirements of the program, including time commitment, please visit or contact or 850-444-7147.
By signing below,I amindicatingthatI amauthorizedto endorsethefullparticipationofthiscandidate.I also understandthatifproperlyengaged,theLoaned Executivewillreceivevaluabletraining,publicspeakingexperience, networking opportunitiesandleadershipskills.
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Print NameTitle
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SignatureDate
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E-mailPhone
Return completed application to
/ 2017-18 Loaned Executive (LE)Program Calendar
Application Deadline / February 3, 2017
Community Investment Committee
Review grant requests from local nonprofits seeking funds generated by the Workplace Campaign. Serving on the CIC is not a required part of the LE program, but it is strongly encouraged. / February – May
approximately 10 hours per month
Community Impact Event (optional)
Sanders Beach-Corinne Jones Center
913 S. I St., Pensacola 32502 / June 15
5-7pm
Loaned ExecutiveOrientation (MANDATORY)
United Way of Escambia County
1301 W. Government St, Pensacola 32502 / July 12
8am – 4pm
Workplace Campaigns
Support the planning, organization, implementation, and successful completion of fundraising activities within assigned local workplaces. / August – January
approximately 5 hours per month
Leadership Training Session & Partner Agency Tours
United Way of Escambia County
1301 W. Government St, Pensacola 32502 / August 10
8:15am – 12:30pm
United Way of Escambia County Annual Meeting (optional) / August
Campaign Kickoff Celebration (optional)
Pensacola Bay Center
201 E. Gregory St, Pensacola 32502 / September 12
11-1pm
Leadership Training Session
United Way of Escambia County
1301 W. Government St, Pensacola 32502 / September 14
8:30-11:30am
Leadership Training Session
United Way of Escambia County
1301 W. Government St, Pensacola 32502 / October 12
8:30-11:30am
Day of Caring (optional) / October 13
Leadership Training Session
United Way of Escambia County
1301 W. Government St, Pensacola 32502 / November 9
8:30-11:30am
Leadership Training Session
United Way of Escambia County
1301 W. Government St, Pensacola 32502 / December 14
8:30-11:30am
LE Appreciation Luncheon
TBD / January 11, 2018
11:30-1pm