Please submit your completed application by January 31, 2020. The selection committee will review all applications and notify participants of their status by February 28, 2020. Participation is available to one eligible person per county per year, with a maximum of 12 participants per year. Eligible participants are the CCAP voting members in each county: county commissioners, council members, chief clerks, county administrators, and solicitors. Key county leaders and department heads may apply by including one written letter of support from their county commissioner/council member.

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* 1. Name:

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* 3. Title:

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* 4. Time in this Position:

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* 5. Phone:

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* 6. Email:

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* 7. Address (indicate valid address where you would like text and materials shipped):

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* 8. Address Type:

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* 9. Cell Phone Number:

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* 10. Can we share the cell number with other program participants?

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* 11. Emergency Contact Information (if we need to contact someone during the program):

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* 12. Dietary Needs or ADA requirements:

VISION STATEMENT: State briefly why you want to participate in the Center for Excellence in County Leadership (CEL) Program and how it would benefit you professionally and personally.

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* 13. VISION STATEMENT:

BACKGROUND INFORMATION: Resumes are encouraged, but not required. You may attach an electronic resume under question 15 (resume attachment), send files to mglantz@pacounties.org, or describe/list below county positions held, including political offices (supply date of election, appointment or hire); professional and business activities since your completion of your education; academic history beginning with high school and listing degrees earned and honor designations; professional county-related or academic associations or business affiliations to which you belong; contribution of time and effort to civic or charitable courses; and, other personal interests pertinent to this application.

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* 14. BACKGROUND INFORMATION:

COST: The tuition for the CEL program is $850 per person which includes course registration and program materials, overnight accommodations for three nights, continental breakfast and lunch for three days and an evening networking reception. Participants will be notified of their acceptance into the program by February 28, 2020 and will be invoiced at that time. Final payment for participation is due in full by April 15, 2020.
CANCELLATION: Due to the nature of the program and advance materials which are sent to all participants in early spring, written notification of cancellation must be sent to mglantz@pacounties.org by 4 p.m. on March 15, 2020 to avoid penalty. Valid cancellations received in writing by 4 p.m. on April 15, 2020 are subject to an administrative charge of 25 percent of the program value; cancellations received by 4 p.m. May 15, 2020 are subject to an administrative charge of 50 percent of the program value. All refunds are issued via check. There are no refunds for cancellations received after 4 p.m. on May 15, 2020.
COMMITMENT STATEMENT: To promote maximum learning amongst attendees, completion of all advance coursework including review of the text and completion of the assessments as well as full attendance at each day of the program is expected and required. Please note the CEL is a learning community where being on time, not leaving prematurely, and full participation are crucial to the dynamics of the learning process. Commitment to the process of creating a community for inquiry, receptivity, and discussion should be respected. Thank you for your cooperation and understanding of this commitment.

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* 15. Resume Attachment:

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LETTER OF SUPPORT: A letter of support from the applicants county commissioner/council member is required for individuals who are not a county executive, county commissioner/council member, chief clerk, county administrator or county solicitor. Please attach below under question 16 (letter of support attachment) or send file to mglantz@pacounties.org.

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* 16. Letter of Support Attachment:

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