Community Leadership Accelerator 2019 Application

Instructions

Thank you for making the decision to invest in your leadership and community. We are excited that you are taking this important step! If you have not already, please share information about this program with other leaders who you think would be a good fit.

We have designed the application to learn more about who you are as a person and a leader. Please answer as honestly as you can.

Thanks to Vitalyst Health Foundation, and other community partners, we are able to offer financial assistance. There is a separate application, the link to which can be found at the end of this application. Resources are limited, so please only ask for what you need.

The application deadline is midnight on December 1. We will be reviewing applications, and scholarship requests in December, with the goal of confirming your participation in the program by December 20.

In the meantime, please hold the dates for the opening retreat (January 21-23, in Ajo) and closing retreat (May 14-15, also in Ajo) on your calendars.

All the best,

Sarah Griffiths, The Next Chapter Consulting and Coaching
Bryn Jones, Elan Consulting

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* 1. Tell us a bit about yourself:

Name:

Organization(s):

Position(s):

Age:

Email address:

Phone number:

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* 2. Would you like us to use a preferred name? If yes, what?

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* 3. What is your gender identity?

Woman

Man

Genderqueer or non-binary

Agender

Prefer not to respond

Other (please specify)

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* 4. Do you identify as transgender (or another non-cisgender identity)?

Yes

Prefer not to respond

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* 5. What is your sexual orientation? Check all that apply.

Asexual

Bisexual

Gay

Heterosexual or straight

Lesbian

Pansexual

Queer

Prefer not to respond

Other (please specify)

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* 6. What is your racial or ethnic identity? (Select all that apply.)

African-American/Black

East Asian

Hispanic/Latinx

Middle Eastern

American Indian/Alaskan Native

Pacific Islander

South Asian

Southeast Asian

White

Prefer not to respond

Other (please specify)

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* 7. Are you a person living with a disability?

Yes

Prefer not to respond

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* 8. Is english your first language?

Yes

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* 9. Why are you interested in this program? What do you want to get out of it?

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* 10. Tell us a little about the personal and/or professional development that you've done to date.

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* 11. Describe where and how you currently show up as a leader.

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* 12. Describe where and how you previously have shown up as a leader.

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* 13. On a scale of 1-10 (10 being your ideal), how would you rate your work/life balance?

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 14. On a scale of 1-10 (with 10 being the most ready), how ready are you for self-exploration?

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 15. When you think of yourself as a whole organizational and/or community leader, what 3 areas would you most like to develop in yourself?

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* 16. What strengths, qualities, and/or gifts do you bring to your leadership?

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* 17. If you were feeling most effective and authentic as a leader, what might that look and feel like?

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* 18. This is a program aimed at developing diverse leaders who are grounded in their own leadership, can sustain themselves as leaders, and can drive community change. What community change are you working towards and/or would like to work towards?

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* 19. Choose the number that best represents where you feel you are currently (1 is low. 10 is high). How would you rate yourself?

	1	2	3	4	5	6	7	8	9	10
Overall confidence level as a leader	Overall confidence level as a leader 1	Overall confidence level as a leader 2	Overall confidence level as a leader 3	Overall confidence level as a leader 4	Overall confidence level as a leader 5	Overall confidence level as a leader 6	Overall confidence level as a leader 7	Overall confidence level as a leader 8	Overall confidence level as a leader 9	Overall confidence level as a leader 10
Managing conflict	Managing conflict 1	Managing conflict 2	Managing conflict 3	Managing conflict 4	Managing conflict 5	Managing conflict 6	Managing conflict 7	Managing conflict 8	Managing conflict 9	Managing conflict 10
Maintaining a positive outlook	Maintaining a positive outlook 1	Maintaining a positive outlook 2	Maintaining a positive outlook 3	Maintaining a positive outlook 4	Maintaining a positive outlook 5	Maintaining a positive outlook 6	Maintaining a positive outlook 7	Maintaining a positive outlook 8	Maintaining a positive outlook 9	Maintaining a positive outlook 10
Admitting what you don't know	Admitting what you don't know 1	Admitting what you don't know 2	Admitting what you don't know 3	Admitting what you don't know 4	Admitting what you don't know 5	Admitting what you don't know 6	Admitting what you don't know 7	Admitting what you don't know 8	Admitting what you don't know 9	Admitting what you don't know 10
Practicing active listening	Practicing active listening 1	Practicing active listening 2	Practicing active listening 3	Practicing active listening 4	Practicing active listening 5	Practicing active listening 6	Practicing active listening 7	Practicing active listening 8	Practicing active listening 9	Practicing active listening 10
Asking more questions	Asking more questions 1	Asking more questions 2	Asking more questions 3	Asking more questions 4	Asking more questions 5	Asking more questions 6	Asking more questions 7	Asking more questions 8	Asking more questions 9	Asking more questions 10
Expressing gratitude	Expressing gratitude 1	Expressing gratitude 2	Expressing gratitude 3	Expressing gratitude 4	Expressing gratitude 5	Expressing gratitude 6	Expressing gratitude 7	Expressing gratitude 8	Expressing gratitude 9	Expressing gratitude 10
Being open to risks	Being open to risks 1	Being open to risks 2	Being open to risks 3	Being open to risks 4	Being open to risks 5	Being open to risks 6	Being open to risks 7	Being open to risks 8	Being open to risks 9	Being open to risks 10
Taking action	Taking action 1	Taking action 2	Taking action 3	Taking action 4	Taking action 5	Taking action 6	Taking action 7	Taking action 8	Taking action 9	Taking action 10
Developing others as leaders	Developing others as leaders 1	Developing others as leaders 2	Developing others as leaders 3	Developing others as leaders 4	Developing others as leaders 5	Developing others as leaders 6	Developing others as leaders 7	Developing others as leaders 8	Developing others as leaders 9	Developing others as leaders 10
Having awareness of and managing emotions (in yourself)	Having awareness of and managing emotions (in yourself) 1	Having awareness of and managing emotions (in yourself) 2	Having awareness of and managing emotions (in yourself) 3	Having awareness of and managing emotions (in yourself) 4	Having awareness of and managing emotions (in yourself) 5	Having awareness of and managing emotions (in yourself) 6	Having awareness of and managing emotions (in yourself) 7	Having awareness of and managing emotions (in yourself) 8	Having awareness of and managing emotions (in yourself) 9	Having awareness of and managing emotions (in yourself) 10
Having awareness of and managing emotions (in others)	Having awareness of and managing emotions (in others) 1	Having awareness of and managing emotions (in others) 2	Having awareness of and managing emotions (in others) 3	Having awareness of and managing emotions (in others) 4	Having awareness of and managing emotions (in others) 5	Having awareness of and managing emotions (in others) 6	Having awareness of and managing emotions (in others) 7	Having awareness of and managing emotions (in others) 8	Having awareness of and managing emotions (in others) 9	Having awareness of and managing emotions (in others) 10
Managing time effectively	Managing time effectively 1	Managing time effectively 2	Managing time effectively 3	Managing time effectively 4	Managing time effectively 5	Managing time effectively 6	Managing time effectively 7	Managing time effectively 8	Managing time effectively 9	Managing time effectively 10
Setting and maintaining boundaries	Setting and maintaining boundaries 1	Setting and maintaining boundaries 2	Setting and maintaining boundaries 3	Setting and maintaining boundaries 4	Setting and maintaining boundaries 5	Setting and maintaining boundaries 6	Setting and maintaining boundaries 7	Setting and maintaining boundaries 8	Setting and maintaining boundaries 9	Setting and maintaining boundaries 10
Taking care of yourself (mind, body, spirit)	Taking care of yourself (mind, body, spirit) 1	Taking care of yourself (mind, body, spirit) 2	Taking care of yourself (mind, body, spirit) 3	Taking care of yourself (mind, body, spirit) 4	Taking care of yourself (mind, body, spirit) 5	Taking care of yourself (mind, body, spirit) 6	Taking care of yourself (mind, body, spirit) 7	Taking care of yourself (mind, body, spirit) 8	Taking care of yourself (mind, body, spirit) 9	Taking care of yourself (mind, body, spirit) 10
Understanding yourself as an authentic leader	Understanding yourself as an authentic leader 1	Understanding yourself as an authentic leader 2	Understanding yourself as an authentic leader 3	Understanding yourself as an authentic leader 4	Understanding yourself as an authentic leader 5	Understanding yourself as an authentic leader 6	Understanding yourself as an authentic leader 7	Understanding yourself as an authentic leader 8	Understanding yourself as an authentic leader 9	Understanding yourself as an authentic leader 10
Collaborating and sharing leadership	Collaborating and sharing leadership 1	Collaborating and sharing leadership 2	Collaborating and sharing leadership 3	Collaborating and sharing leadership 4	Collaborating and sharing leadership 5	Collaborating and sharing leadership 6	Collaborating and sharing leadership 7	Collaborating and sharing leadership 8	Collaborating and sharing leadership 9	Collaborating and sharing leadership 10

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* 20. All meetings will take place during the work-week. Outlined here are the program components:

Program:
5-month program with 15- 20 participants from Southern Arizona, Phoenix and all the communities between and around

Opening Retreat (month 1):

3-day opening retreat in Ajo (January 21-23)

Monthly Commitments (months 2, 3 and 4):

A 3-hour reflection and application circle (dates TBD)

A paired call with another participant (approximately 1-hour)

Homework, including readings (no more than 2 hours/week of materials), practices, assessments, etc.

Closing Retreat (month 5):

1 ½ -day closing retreat in Ajo (May 14-15)

In addition:

Each participant will receive two coaching sessions

Are you willing and able to commit to participating in all program components?

Yes

I would like to have more conversation with you about this

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* 21. We use the Enneagram personality typing system in this program. If you're not familiar with it, here's a link so you can learn more: https://www.enneagraminstitute.com/ Have you ever taken the Enneagram Assessment?

No, but I'll take it and pay the $12

No. I'm willing to take the assessment, but I can't afford the $12

I'd rather not take the assessment

Yes, and I know my type

Please tell us your type or why you don't want to take the assessment.

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* 22. What else, if anything, would you like us to know?

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* 23. What supports, if any, might you need to be able to fully participate?

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* 24. Do you have any dietary needs that we should be aware of as we plan meals?

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* 25. The cost of the program is $2,500* per person (10% discount for participants in Southern Arizona Nonprofit CEO Roundtable member organizations), due before the first retreat. (*This amount does not cover lodging costs or evening meals for the retreats. Breakfasts (where applicable), lunches and refreshments during the retreats and all curricula and materials are included).

We understand that this is an investment and have given some time to think of ways to fund participation:

Your organization covers the cost

You share a portion of the cost with your organization

You pay yourself

You raise funds for part of the cost

We provide some support

Through funding by Vitalyst Health Foundation and other community partners (including the Community Food Bank of Southern Arizona, the Community Foundation for Southern Arizona, and Elan Consulting and The Next Chapter), we are able to offer financial assistance.

Our goal is to provide assistance to as many people as need it. If you've already been informed that a community partner is sponsoring you and that sponsorship covers all your needs, you don't need to apply for assistance.

We ask those who need assistance to pay the highest amount you can reasonably afford so we may support others and their needs as well.

With that in mind, will you need a scholarship? (The link to the Scholarship Application is on the next page of this application).

Yes

A community partner is sponsoring me

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